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. 2018 Jul 5;131(13):1541-1548.
doi: 10.4103/0366-6999.235111.

Pelvic Exenteration for Recurrent and Persistent Cervical Cancer

Lei Li  1 , Shui-Qing Ma  1 , Xian-Jie Tan  1 , Sen Zhong  1 , Ming Wu  1
Affiliations

Pelvic Exenteration for Recurrent and Persistent Cervical Cancer

Lei Li et al. Chin Med J (Engl). .

Abstract
in English, Chinese

Background: Pelvic exenteration (PE) for primary and recurrent cervical cancer has resulted in favorable survival outcomes, but there are controversies about specific prognosis factors, and up to now, there have been no published reports from China. This study aimed to share our experiences of PE, which were performed in a single institution.

Methods: From January 2009 to January 2016, 38 patients with recurrent or persistent cervical cancer were included in the study, and they were followed up until January 2017. Epidemiological and clinicopathological characteristics of patients were compared for survival outcomes in univariate and Cox hazard regression analysis.

Results: There were thirty-one and seven patients with recurrent and persistent cervical cancer, respectively. The median age of patients was 45 years (range 29-65 years). Total, anterior, and posterior PE consisted of 52.6%, 28.9%, and 18.4% of cases, respectively. Early and late complications occurred in 21 (55.3%) patients and 15 (39.5%) patients, respectively. Two (5.3%) patients died due to complications related to surgeries within 3 months after PE. The median overall survival (OS) and disease-free survival (DFS) were 28.5 months (range 9-96 months) and 23 months (range 4-96 months), respectively, and 5-year OS and DFS were 48% and 40%, respectively. Cox hazard regression analysis showed that, the margin status of the incision and mesorectal lymph node status were independent risk factors for OS and DFS.

Conclusion: In our patients with recurrent and persistent cervical cancer, the practice of PE might achieve favorable survival outcomes.

Trial registration: ClinicalTrials.gov, NCT03291275; https://clinicaltrials.gov/ct2/show/NCT03291275?term=NCT03291275&rank=1.

盆腔廓清术治疗复发性及未控性宫颈癌摘要背景：盆腔廓清术（PE）治疗原发和复发性宫颈癌的生存预后较好，但是有关预后因素仍有很多争议，迄今也没有来自中文的报道。本研究旨在分享我们施行PE的经验，所有手术均在一家医院进行。 方法：从2009年1月到2016年1月，38例复发性或未控性宫颈癌纳入研究，随访至2017年1月。以单因素分析和Cox风险回归模型分析患者流行病学和临床病理特点对生存结局的影响。 结果：复发性和未控性宫颈癌患者分别31例和7例，中位年龄45岁（范围29-65岁）。全盆腔廓清术、前盆腔廓清术和后盆腔廓清术分别占52.6%、28.9%和18.4%。分别有21例（55.3%）和15例（39.5%）患者在术后发生了早期合并症和晚期合并症。两例患者（5.3%）在PE术后3个月内死于合并症。中位总体生存率（OS）和无病生存率（DFS）分别为28.5个月（范围9-96个月）和23个月（范围4-96个月），5年OS率和DFS率分别为48%和40%。Cox风险回归分析显示，切缘状态、直肠系膜淋巴结状态是影响OS和DFS的独立的预后因素。 结论：在我们的研究中，复发和未控性宫颈癌患者在盆腔廓清术后可能有较好的预后结果。 研究注册：ClinicalTrials.gov, NCT03291275; https://clinicaltrials.gov/ct2/show/NCT03291275?term=NCT03291275&rank=1.

Keywords: Cervical Cancer; Pelvic Exenteration; Survival.

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Conflict of interest statement

There are no conflicts of interest

Figures

Figure 1
Figure 1
OS curves of the patients described by Kaplan-Meier tests. (a) OS of positive and negative margins of the incisions (χ2=19.325, P value of log-rank test <0.001). (b) OS of positive and negative mesorectal lymph nodes (χ2= 7.060, P value of log-rank test is 0.008). OS: Overall survival.
Figure 2
Figure 2
DFS curves of the patients described by Kaplan-Meier tests. (a) DFS of positive and negative margins of the incisions (χ2=18.524, P value of log-rank test <0.001). (b) DFS of positive and negative mesorectal lymph nodes (χ2=5.909, P value of log-rank test is 0.019). DFS: Disease-free survival.
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