Lancet Oncol:宫颈癌开腹手术与微创(腹腔镜)手术(LACC)后的生活质量研究:一项多中心、随机、开放标签、3期、非劣效性试验的次要结局

2021-09-22 倪新雨 张师前 张师前公众号

LACC试验表明,在早期宫颈癌患者中,微创手术后的死亡风险和复发率均高于开腹手术,并在多个回顾性研究中得以证实。LACC试验的不良事件数据显示,开放手术组的失血量明显高于微创手术组,但术中并发症、术后

LACC试验表明,在早期宫颈癌患者中,微创手术后的死亡风险和复发率均高于开腹手术,并在多个回顾性研究中得以证实。LACC试验的不良事件数据显示,开放手术组的失血量明显高于微创手术组,但术中并发症、术后早期或延迟性不良事件、重大不良事件方面,两组之间并没有差异。

到目前为止,还没有对宫颈癌根治性子宫切除术后生活质量进行的随机对照研究。LACC试验是一项多中心、随机、开放标签、3期、非劣效性试验。LACC试验的主要结局是比较开放和微创手术之间的无病生存率。本文主要报告LACC试验中的次要结局,即对生活质量进行评估。

该项试验的纳入标准:18岁以上宫颈癌患者,病理类型为腺癌、鳞状细胞癌或腺鳞癌,2型或3型根治性子宫切除术,ECOG)评分0-1,FIGO临床分期为IA1伴淋巴管侵犯,IA2,或IB1 (肿瘤≤4cm,局限于宫颈)。排除标准:肿瘤>4cm,FIGO分期IB2-IVB,有盆腔或腹部放疗史,有转移证据,或研究者认为不适合手术。

试验流程:对1185位病例进行筛查,最终纳入631例(排除549例,其中280人不符合入组标准、205例拒绝参加试验、64例因其他原因)。将其随机分为两组,分别是经腹手术组(312)、微创手术组(319)。两组分别又有38例和30例因手术、分组原因而被排除,最终两组分别有274例和289例患者接受了相应的手术治疗。纳入意向性分析的患者两组分别有68例和67例被排除生活质量评估,最终经腹手术组244例、微创手术组252例进入生活质量次要结局的统计分析。

下表比较了两组的基线临床资料:包括年龄、ECOG评分、地域、病理类型(腺癌、鳞癌、腺鳞癌)、FIGO分期(淋巴脉管间隙浸润的IA1期、IA2期、IB1期)、手术方式(开腹、微创)、术后辅助、开腹切口类型等。两组的基线临床资料无明显的统计学差异。

图片

2型或3型根治性子宫切除术和盆腔淋巴结清扫术,术后辅助化疗参考sedlis标准。术前、术后6周以及术后3个月分别对两组患者进行FACT-Cx量表、MDASI量表、SF-12量表、EQ-5D量表的生活质量进行评估,绘制生活质量变化曲线,曲线变化如下。

图片

在基线检查时,开放手术组和微创手术组之间的FACT-Cx总分没有差异。两组在术后6周或术后3个月也没有发现差异。开放手术组和微创手术组的其余综合生活质量评分(SF-12生理和心理评分、MDASI症状和干扰评分以及EQ-5D身体状态评分)的基线评估、术后不同时间点的得分相似,没有统计学差异。

 

图片

结论

微创与开腹根治性子宫切除术的术后生活质量相似,鉴于微创手术复发率比开放手术高,无病生存率低,建议早期宫颈癌患者行开放性根治性子宫切除术。

两个队列生活质量不存在差异的原因:

1.  生活质量评分与手术并发症的关系可能比手术入路更密切,LACC试验中两组在术中并发症方面没有差异,故可能导致生活质量无差异。

2.  两组患者BMI值均为27Kg/m,低于肥胖阈值,也有可能导致生活质量没有差异。

3.  多学科联合ERAS的广泛应用,减少了手术患者的生理以及心理的创伤应激,达到快速康复的目的,进而生活质量差异较小。

文章的优点

1.  再次确证早期宫颈癌经腹手术更佳,从生活质量角度进一步支持经腹手术在早期宫颈癌治疗中的地位。

2.  样本量足够多。

3.  五种量表进行评价,各取所长互相补充。

原始出处:
Frumovitz M, Obermair A, Coleman RL, Pareja R, Lopez A, Ribero R, Isla D, Rendon G, Bernardini MQ, Buda A, Moretti-Marquez R, Zevallos A, Vieira MA, Zhu T, Land RP, Nicklin J, Asher R, Robledo KP, Gebski V, Ramirez PT. Quality of life in patients with cervical cancer after open versus minimally invasive radical hysterectomy (LACC): a secondary outcome of a multicentre, randomised, open-label, phase 3, non-inferiority trial.Lancet Oncol. 2020 Jun;21(6):851-860.

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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1408299, encodeId=d1b8140829921, content=<a href='/topic/show?id=92194628826' target=_blank style='color:#2F92EE;'>#宫颈#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46288, encryptionId=92194628826, topicName=宫颈)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=11102737131, createdName=一闲, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1904080, encodeId=d41d19040803e, content=<a href='/topic/show?id=7d454302945' target=_blank style='color:#2F92EE;'>#多中心#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43029, encryptionId=7d454302945, topicName=多中心)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Sun Sep 26 13:55:01 CST 2021, time=2021-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1907937, encodeId=7bb1190e937c3, content=<a href='/topic/show?id=b3c199328f2' target=_blank style='color:#2F92EE;'>#非劣效#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99328, encryptionId=b3c199328f2, topicName=非劣效)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac1c235, createdName=tonychen21, createdTime=Thu Feb 24 22:55:01 CST 2022, time=2022-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819180, encodeId=42ec18191802e, content=<a href='/topic/show?id=5ac499329f0' target=_blank style='color:#2F92EE;'>#非劣效性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99329, encryptionId=5ac499329f0, topicName=非劣效性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d39f177, createdName=lixiao3326, createdTime=Thu Mar 24 13:55:01 CST 2022, time=2022-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2053320, encodeId=e0042053320ba, content=<a href='/topic/show?id=d41599331a8' target=_blank style='color:#2F92EE;'>#非劣效性试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99331, 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channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu Dec 30 07:55:01 CST 2021, time=2021-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1276488, encodeId=f4e912e6488ad, content=<a href='/topic/show?id=768685612db' target=_blank style='color:#2F92EE;'>#腹腔镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85612, encryptionId=768685612db, topicName=腹腔镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=xinxin088, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1317103, encodeId=ab15131e10372, content=<a 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  5. [GetPortalCommentsPageByObjectIdResponse(id=1904080, encodeId=d41d19040803e, content=<a href='/topic/show?id=7d454302945' target=_blank style='color:#2F92EE;'>#多中心#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43029, encryptionId=7d454302945, topicName=多中心)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Sun Sep 26 13:55:01 CST 2021, time=2021-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1907937, encodeId=7bb1190e937c3, content=<a href='/topic/show?id=b3c199328f2' target=_blank style='color:#2F92EE;'>#非劣效#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99328, encryptionId=b3c199328f2, topicName=非劣效)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac1c235, 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channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu Dec 30 07:55:01 CST 2021, time=2021-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1276488, encodeId=f4e912e6488ad, content=<a href='/topic/show?id=768685612db' target=_blank style='color:#2F92EE;'>#腹腔镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85612, encryptionId=768685612db, topicName=腹腔镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=xinxin088, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1317103, encodeId=ab15131e10372, content=<a href='/topic/show?id=df8950505a2' target=_blank style='color:#2F92EE;'>#微创#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50505, encryptionId=df8950505a2, topicName=微创)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644e456, createdName=vera_1203, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326858, encodeId=b0f813268581c, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1408299, encodeId=d1b8140829921, content=<a href='/topic/show?id=92194628826' target=_blank style='color:#2F92EE;'>#宫颈#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46288, encryptionId=92194628826, topicName=宫颈)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=11102737131, createdName=一闲, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=)]
    2022-04-01 minlingfeng
  6. [GetPortalCommentsPageByObjectIdResponse(id=1904080, encodeId=d41d19040803e, content=<a href='/topic/show?id=7d454302945' target=_blank style='color:#2F92EE;'>#多中心#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43029, encryptionId=7d454302945, topicName=多中心)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Sun Sep 26 13:55:01 CST 2021, time=2021-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1907937, encodeId=7bb1190e937c3, content=<a href='/topic/show?id=b3c199328f2' target=_blank style='color:#2F92EE;'>#非劣效#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99328, encryptionId=b3c199328f2, topicName=非劣效)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac1c235, 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href='/topic/show?id=df8950505a2' target=_blank style='color:#2F92EE;'>#微创#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50505, encryptionId=df8950505a2, topicName=微创)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644e456, createdName=vera_1203, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326858, encodeId=b0f813268581c, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1408299, encodeId=d1b8140829921, content=<a href='/topic/show?id=92194628826' target=_blank style='color:#2F92EE;'>#宫颈#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46288, encryptionId=92194628826, topicName=宫颈)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=11102737131, createdName=一闲, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=)]
    2021-12-30 howi
  7. [GetPortalCommentsPageByObjectIdResponse(id=1904080, encodeId=d41d19040803e, content=<a href='/topic/show?id=7d454302945' target=_blank style='color:#2F92EE;'>#多中心#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43029, encryptionId=7d454302945, topicName=多中心)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Sun Sep 26 13:55:01 CST 2021, time=2021-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1907937, encodeId=7bb1190e937c3, content=<a href='/topic/show?id=b3c199328f2' target=_blank style='color:#2F92EE;'>#非劣效#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99328, encryptionId=b3c199328f2, topicName=非劣效)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac1c235, createdName=tonychen21, createdTime=Thu Feb 24 22:55:01 CST 2022, time=2022-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819180, encodeId=42ec18191802e, content=<a href='/topic/show?id=5ac499329f0' target=_blank style='color:#2F92EE;'>#非劣效性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99329, encryptionId=5ac499329f0, topicName=非劣效性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d39f177, createdName=lixiao3326, createdTime=Thu Mar 24 13:55:01 CST 2022, time=2022-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2053320, encodeId=e0042053320ba, content=<a href='/topic/show?id=d41599331a8' target=_blank style='color:#2F92EE;'>#非劣效性试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99331, encryptionId=d41599331a8, topicName=非劣效性试验)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fd18451, createdName=xre2008, createdTime=Fri Jan 21 11:55:01 CST 2022, time=2022-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1866238, encodeId=177c18662385e, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Fri Apr 01 16:55:01 CST 2022, time=2022-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1831309, encodeId=2908183130974, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu Dec 30 07:55:01 CST 2021, time=2021-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1276488, encodeId=f4e912e6488ad, content=<a href='/topic/show?id=768685612db' target=_blank style='color:#2F92EE;'>#腹腔镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85612, encryptionId=768685612db, topicName=腹腔镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=xinxin088, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1317103, encodeId=ab15131e10372, content=<a href='/topic/show?id=df8950505a2' target=_blank style='color:#2F92EE;'>#微创#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50505, encryptionId=df8950505a2, topicName=微创)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644e456, createdName=vera_1203, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326858, encodeId=b0f813268581c, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1408299, encodeId=d1b8140829921, content=<a href='/topic/show?id=92194628826' target=_blank style='color:#2F92EE;'>#宫颈#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46288, encryptionId=92194628826, topicName=宫颈)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=11102737131, createdName=一闲, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1904080, encodeId=d41d19040803e, content=<a href='/topic/show?id=7d454302945' target=_blank style='color:#2F92EE;'>#多中心#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43029, encryptionId=7d454302945, topicName=多中心)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Sun Sep 26 13:55:01 CST 2021, time=2021-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1907937, encodeId=7bb1190e937c3, content=<a href='/topic/show?id=b3c199328f2' target=_blank style='color:#2F92EE;'>#非劣效#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99328, encryptionId=b3c199328f2, topicName=非劣效)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac1c235, createdName=tonychen21, createdTime=Thu Feb 24 22:55:01 CST 2022, time=2022-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819180, encodeId=42ec18191802e, content=<a href='/topic/show?id=5ac499329f0' target=_blank style='color:#2F92EE;'>#非劣效性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99329, encryptionId=5ac499329f0, topicName=非劣效性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d39f177, createdName=lixiao3326, createdTime=Thu Mar 24 13:55:01 CST 2022, time=2022-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2053320, encodeId=e0042053320ba, content=<a href='/topic/show?id=d41599331a8' target=_blank style='color:#2F92EE;'>#非劣效性试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99331, encryptionId=d41599331a8, topicName=非劣效性试验)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fd18451, createdName=xre2008, createdTime=Fri Jan 21 11:55:01 CST 2022, time=2022-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1866238, encodeId=177c18662385e, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Fri Apr 01 16:55:01 CST 2022, time=2022-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1831309, encodeId=2908183130974, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu Dec 30 07:55:01 CST 2021, time=2021-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1276488, encodeId=f4e912e6488ad, content=<a href='/topic/show?id=768685612db' target=_blank style='color:#2F92EE;'>#腹腔镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85612, encryptionId=768685612db, topicName=腹腔镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=xinxin088, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1317103, encodeId=ab15131e10372, content=<a href='/topic/show?id=df8950505a2' target=_blank style='color:#2F92EE;'>#微创#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50505, encryptionId=df8950505a2, topicName=微创)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644e456, createdName=vera_1203, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326858, encodeId=b0f813268581c, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1408299, encodeId=d1b8140829921, content=<a href='/topic/show?id=92194628826' target=_blank style='color:#2F92EE;'>#宫颈#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46288, encryptionId=92194628826, topicName=宫颈)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=11102737131, createdName=一闲, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=)]
    2021-09-24 vera_1203
  9. [GetPortalCommentsPageByObjectIdResponse(id=1904080, encodeId=d41d19040803e, content=<a href='/topic/show?id=7d454302945' target=_blank style='color:#2F92EE;'>#多中心#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43029, encryptionId=7d454302945, topicName=多中心)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Sun Sep 26 13:55:01 CST 2021, time=2021-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1907937, encodeId=7bb1190e937c3, content=<a href='/topic/show?id=b3c199328f2' target=_blank style='color:#2F92EE;'>#非劣效#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99328, encryptionId=b3c199328f2, topicName=非劣效)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac1c235, 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1408299, encodeId=d1b8140829921, content=<a href='/topic/show?id=92194628826' target=_blank style='color:#2F92EE;'>#宫颈#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46288, encryptionId=92194628826, topicName=宫颈)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=11102737131, createdName=一闲, createdTime=Fri Sep 24 04:55:01 CST 2021, time=2021-09-24, status=1, ipAttribution=)]
  10. [GetPortalCommentsPageByObjectIdResponse(id=1904080, encodeId=d41d19040803e, content=<a href='/topic/show?id=7d454302945' target=_blank style='color:#2F92EE;'>#多中心#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43029, encryptionId=7d454302945, topicName=多中心)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Sun Sep 26 13:55:01 CST 2021, time=2021-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1907937, encodeId=7bb1190e937c3, content=<a href='/topic/show?id=b3c199328f2' target=_blank style='color:#2F92EE;'>#非劣效#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99328, encryptionId=b3c199328f2, topicName=非劣效)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac1c235, 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