This study aimed to explore the survival outcomes of early-stage cervical CC patients treated with laparoscopic/abdominal radical hysterectomy (LRH/ARH).
We performed a retrospective analysis involving women who had underwent LRH/ARH for CC in early stage during the 2013–2015 period in West China Second University Hospital. The survival outcomes and potential prognostic factors were evaluated using Kaplan-Meier method and Cox regression analysis, respectively.
A total of 678 patients were included in our analysis. The overall survival (OS) and progression-free survival (PFS) between the ARH (n = 423) and LRH (n = 255) groups achieved no significant differences (p = 0.122, 0.285, respectively). However, in the patients with locally advanced CC (LACC), the OS of LRH group was significantly shorter than that of ARH group (p = 0.017). Conversely, in patients with a tumor diameter ≤4 cm, the LRH group had a significantly longer OS than the ARH group (p = 0.013). The multivariate Cox analysis revealed that FIGO stage, histology, parametrial invasion and pelvic lymph node invasion were independent prognostic factors for OS and PFS, whereas surgical method was not a statistically significant predictor of OS (p = 0.806) or PFS (p = 0.236) in CC patients.
LRH was associated with poorer prognosis compared with ARH in LACC. Priority should be given to ARH for the surgical treatment of patients with LACC.
This study was undertaken after approved by the ethics committee of West China Second University Hospital.
West China Second University Hospital.
Sichuan Youth Foundation of Science of Technology.
The author has declared no conflicts of interest.
To compare the long-term oncologic outcome of laparoscopic radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) for patients with stage Ia1-Ib3 cervical cancer.
A retrospective data of stage Ia1-Ib1 cervical cancer patients who underwent LRH and ARH at Sun Yat-sen University Cancer Center from Jan. 2012 to Dec. 2015 was collected. Patients were re-classified according to the 2018 FIGO staging system for cervical cancer and screened out 679 cases with stage Ia1-Ib3 cervical cancer. Propensity score matching (PSM) was performed by software SPSS 22.0, and a total of 268 patient pairs (LRH-ARH) were enrolled and analyzed. Oncologic outcomes and prognosis factors were compared between patients undergoing LRH vs. ARH.
(1) Baseline characteristics after PSM: There were no statistical differences between LRH and ARH, but only in grade (p = 0.001). (2) Operation related data: The operative time [(228±90) vs (210±54) min], estimated blood loss (EBL) [(129.5±138.2) vs (207.8±204.6) ml], and the length of hospital stay [(10.6±3.5) vs (12.6±3.5) days] in the LRH group were significantly shorter compared with ARH group (all P < 0.001). (3) Recurrence and survival data: There was a significant difference in the 5-year disease-free survival (DFS; 86.4% vs 95.6%, p = 0.002) and 5-year overall survival (OS; 92.2% vs 97.5%, p = 0.017) between the LRH group and ARH groups. (4) Prognosis factors: In univariate and multivariat analysis, the results showed that surgical approach was common independent prognostic factor for OS and DFS. (5) Stratified analysis: Stratified analysis in low-risk patients with cervical cancer showed that, even in stage Ib1 patients with tumor size <2 cm, there were significant differences for OS and DFS between LRH and ARH group (all P < 0.05). Besides, ALR group only showed better DFS than LRH group in patients with no lymph vascular space invasion.
Our results suggest that, for patients with stage Ia1-Ib3 cervical cancer, ARH results in more benefits for OS and DFS compared with LRH. Even in low-risk patients, ARH is still an oncologically safer alternative.
Sun Yat-sen University Cancer Center.
National Natural Science Fund.
All authors have declared no conflicts of interest.
Durvalumab monotherapy has demonstrated promising objective tumour response (OTR) and safety in advanced endometrial cancer with deficient MMR. We report here updated OTR, progression-free survival (PFS) and overall survival (OS) results based on central pathology MMR review from the PHAEDRA trial.
Participants (pts) had MMR-proficient (pMMR) or -deficient (dMMR) AEC progressing after 0-3 lines of chemotherapy and were treated with durvalumab 1500mg IV Q4W. The primary endpoint was OTR (complete response [CR] or partial response [PR] by iRECIST). Secondary endpoints included PFS, OS, OTR by RECIST 1.1, adverse events, quality of life, and tertiary translational objectives to determine associations between molecular biomarkers and OTR.
71 pts with AEC were recruited from Feb 2017 to Sep 2018: 36 dMMR and 35 pMMR based on central MMR review. Median follow-up for OS were 16 vs 21 months in dMMR vs pMMR pts. Median age: 67 (range 36-81); ECOG PS: 0-1 in 96%, and 2 in 4%. Pathology: endometrioid in 94% and 57%; serous in 0% and 31%; grade 3 (most recent histology): 41% and 85% (dMMR and pMMR respectively). Durvalumab was the 1st, 2nd and subsequent line of non-hormonal therapy in 58%, 39%, and 3% pts with dMMR and 9%, 63%, and 29% pts with pMMR. Among dMMR pts, the OTR rate was 47% (17/36, 95% CI 32-63%): 6 CR, 11 PR and 6 stable disease (SD). OTR rate was 57% as 1st line and 38% as 2nd line. Among pMMR pts, the OTR rate was 3% (1/35, 95% CI 1-15%): 1 PR and 10 SD. Median PFS was 5.5 vs 1.8 months in dMMR vs pMMR pts. 12-month OS was 71% vs 51% in dMMR vs pMMR, with median OS not reached for dMMR vs 11.5 months for pMMR participants.
Durvalumab monotherapy showed promising activity and safety in AEC with dMMR regardless of prior lines of chemotherapy, but there was limited evidence of activity in AEC with pMMR.
University of Sydney.
Y. Antill: Honoraria (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: AstraZeneca; Travel / Accommodation / Expenses: Amgen. M.R. Stockler: Research grant / Funding (institution): As. D. Smith: Honoraria (self): Merck Sharp & Dohme; Shareholder / Stockholder / Stock options: SNP pathology. M.L. Friedlander: Honoraria (self), Advisory / Consultancy: AstraZeneca; Honoraria (self), Advisory / Consultancy: Lilly; Honoraria (self), Advisory / Consultancy: MSD; Honoraria (self), Advisory / Consultancy: Takeda. P.J. Beale: Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Roche. T. Meniawy: Research grant / Funding (self): AstraZeneca.
Several studies have presented value of hysterectomy in GTN, however the indications of hysterectomy in their researches were not single. Pathological reports of specimen after hysterectomy were poorly analyzed in articles available. Our study aims at evaluate the efficiency of hysterectomy applied to GTN patients who had lesions confined to the wall of uterus during chemotherapy in our hospital, and analyze their pathological reports after hysterectomy.
This trial involvs patients of GTN who experienced hysterectomies in our hospital from 2003 to 2016. Each of these patients accepted normative chemotherapy according to their risk score. Hysterectomy was applied during the course of chemotherapy because they had no desire to reserve fertility and lesions confined to uterus were detected by imageologic examinations. Their clinical parameters and pathological reports were collected and outcomes were traced. We also randomly choose GTN patients who had chemotherapy alone in the same period as control group to analyze chemotherapy cycles in two groups.
126 GTN patients experienced hysterectomy during 2003 to 2016 in our hospital. The time period of follow-ups was 24 months to 117 months and 97(76.98%) patients finished follow-ups, with all of these 97 patients survived. 2.06% (2/97) patients experienced recurrence after closure of treatment. Chemotherapy cycles for low risk, non-metastatic patients was 5.04±1.79, while it was 6.62±2.38 in control group, with P value <0.05. Chemotherapy cycles among high risk patients and metastatic patients had no significant differences. For all of the 126 specimen after hysterectomy, vital trophoblastic cells were found in 32.54% (41/126) specimen, of which 31.71%(13/41) patients had negative serum β-HCG(<2IU/L) before hysterectomy.
For GTN patients with lesions confined to wall of uterus, hysterectomy plus chemotherapy is a valid treatment. It can also reduce chemotherapy cycles in low risk, non-metastatic patients. Vital trophoblastic cells may be found in specimen of patients with negative serum β-HCG before hysterectomy.
Has not received any funding.
All authors have declared no conflicts of interest.