Objective: To assess the oncological outcomes of laparoscopic versus open radical hysterectomy (RH) in patients with early-stage cervical cancer using propensity score–matched analysis.Methods: We conducted a retrospective cohort study of 1244 patients who underwent RH with pelvic lymphadenectomy at Chiang Mai University Hospital between 2003 and 2019. Of these, 82 patients received a laparoscopic approach (LAP) and 1162 underwent open radical hysterectomy. Propensity-score matching was performed in a 1:4 ratio using a caliper of 0.2 standard deviations to achieve balance between groups. Overall survival (OS) and progression-free survival (PFS) were analyzed with Kaplan–Meier curves and the log-rank test. Subgroup analysis was conducted based on tumor size (≤ 2 cm vs. > 2 cm). In addition, multivariable Cox proportional hazards models incorporating all relevant clinical and pathological variables were applied to the overall cohort to assess independent predictors of OS and PFS.Results: After matching, 72 LAP RH cases were compared with 279 open RH cases, showing well-balanced baseline features. At 5 years, OS was nearly the same between the LAP and the open groups (95.8% vs. 95.5%;p= 0.95), and PFS was also similar (92.3% vs. 93.8%;p= 0.85). Subgroup analyses demonstrated that LAP RH did not result in a survival disadvantage for tumors ≤ 2 cm or > 2 cm. In multivariable Cox analysis, surgical approach was not an independent predictor of (HR 0.83, 95% CI 0.40–1.71,p= 0.61) or PFS (HR 1.12, 95% CI 0.44–2.84,p= 0.82).Conclusions: In our single-center cohort analyzed using propensity score matching, LAP RH showed long-term oncological outcomes comparable to those of open RH. These results support LAP RH as a safe surgical option for selected patients with early-stage cervical cancer within our setting, where procedures were performed by experienced surgeons following standardized techniques. Further evaluation in diverse clinical contexts is still needed.
目的：采用倾向评分匹配分析，评估腹腔镜与开腹根治性子宫切除术治疗早期宫颈癌患者的肿瘤学结局。 方法：我们对2003年至2019年间在清迈大学医院接受根治性子宫切除联合盆腔淋巴结清扫术的1244例患者进行了回顾性队列研究。其中，82例患者接受腹腔镜手术，1162例接受开腹根治性子宫切除术。采用倾向评分匹配，以1:4的比例、0.2个标准差为卡钳值进行匹配，以实现组间平衡。采用Kaplan-Meier曲线和对数秩检验分析总生存期和无进展生存期。根据肿瘤大小（≤2 cm vs. >2 cm）进行亚组分析。此外，对整体队列应用包含所有相关临床和病理变量的多变量Cox比例风险模型，以评估总生存期和无进展生存期的独立预测因素。 结果：匹配后，72例腹腔镜根治性子宫切除术患者与279例开腹手术患者进行比较，两组基线特征均衡。5年总生存期在腹腔镜组与开腹组间几乎相同（95.8% vs. 95.5%；p=0.95），无进展生存期也相似（92.3% vs. 93.8%；p=0.85）。亚组分析表明，对于肿瘤≤2 cm或>2 cm的患者，腹腔镜手术均未导致生存劣势。在多变量Cox分析中，手术方式并非总生存期（HR 0.83，95% CI 0.40–1.71，p=0.61）或无进展生存期（HR 1.12，95% CI 0.44–2.84，p=0.82）的独立预测因素。 结论：在我们采用倾向评分匹配分析的单中心队列中，腹腔镜根治性子宫切除术显示出与开腹手术相当的长期肿瘤学结局。这些结果支持腹腔镜手术作为本中心特定早期宫颈癌患者的安全手术选择，所有手术均由经验丰富的外科医生按照标准化技术完成。仍需在不同临床背景下进行进一步评估。
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