Objective: To investigate the impact of a prior cervical excisional procedure on the oncologic outcomes of patients with apparent early-stage cervical carcinoma undergoing radical hysterectomy. Methods: The National Cancer Database (2004–2015) was accessed, and patients with FIGO 2009 stage IB1 cervical cancer who had a radical hysterectomy with at least 10 lymph nodes (LNs) removed and a known surgical approach were identified. Patients who did and did not undergo a prior cervical excisional procedure (within 3 months of hysterectomy) were selected for further analysis. Overall survival (OS) was evaluated following the generation of Kaplan–Meier curves and compared with the log-rank test. A Cox model was constructed to control a priori-selected confounders. Results: A total of 3159 patients were identified; 37.1% (n = 1171) had a prior excisional procedure. These patients had lower rates of lymphovascular invasion (29.2% vs. 34.9%,p= 0.014), positive LNs (6.7% vs. 12.7%,p< 0.001), and a tumor size >2 cm (25.7% vs. 56%,p< 0.001). Following stratification by tumor size, the performance of an excisional procedure prior to radical hysterectomy was associated with better OS even after controlling for confounders (aHR: 0.45, 95% CI: 0.30, 0.66). The rate of minimally invasive surgery was higher among patients who had a prior excisional procedure (61.5% vs. 53.2%,p< 0.001). For these patients, performance of minimally invasive radical hysterectomy was not associated with worse OS (aHR: 1.37, 95% CI: 0.66, 2.82). Conclusions: For patients undergoing radical hysterectomy, preoperative cervical excision may be associated with a survival benefit. For patients who had a prior excisional procedure, minimally invasive radical hysterectomy was not associated with worse overall survival.
目的：探讨既往宫颈切除手术对接受根治性子宫切除术的早期宫颈癌患者肿瘤学预后的影响。方法：通过美国国家癌症数据库（2004-2015年）筛选出FIGO 2009分期为IB1期、接受根治性子宫切除术且至少切除10枚淋巴结、手术方式明确的宫颈癌患者。将术前3个月内接受或未接受宫颈切除手术的患者纳入进一步分析。通过绘制Kaplan-Meier生存曲线评估总生存期，并采用对数秩检验进行比较。建立Cox比例风险模型以控制预先选定的混杂因素。结果：共纳入3159例患者，其中37.1%（n=1171）曾接受宫颈切除手术。该组患者的淋巴血管侵犯率（29.2% vs. 34.9%，p=0.014）、淋巴结阳性率（6.7% vs. 12.7%，p<0.001）及肿瘤直径>2 cm的比例（25.7% vs. 56%，p<0.001）均显著较低。按肿瘤大小分层后，即使在控制混杂因素后，根治性子宫切除术前进行宫颈切除手术仍与更好的总生存期相关（调整后风险比：0.45，95%置信区间：0.30-0.66）。既往接受宫颈切除手术的患者中微创手术比例更高（61.5% vs. 53.2%，p<0.001），且微创根治性子宫切除术未导致更差的总生存期（调整后风险比：1.37，95%置信区间：0.66-2.82）。结论：对于接受根治性子宫切除术的患者，术前宫颈切除手术可能带来生存获益。对于曾接受宫颈切除手术的患者，微创根治性子宫切除术与总生存期降低无关。
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