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Long-Term Oncologic Outcomes of Uterine-Preserving Surgery in Young Women With Stage Ib1 Cervical Cancer
  1. Jill H. Tseng, MD,
  2. Alessia Aloisi, MD,
  3. Yukio Sonoda, MD,
  4. Ginger J. Gardner, MD,
  5. Oliver Zivanovic, MD,
  6. Nadeem R. Abu-Rustum, MD and
  7. Mario M. Leitao, MD
  1. Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  1. Address correspondence and reprint requests to Mario M. Leitao Jr, MD, Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065. E-mail: leitaom{at}mskcc.org.

Abstract

Objective This study aimed to evaluate oncologic outcomes of women with stage IB1 cervical cancer treated with uterine-preserving surgery (UPS) (defined as conization or trachelectomy) versus non-UPS (defined as hysterectomy of any type).

Methods The Surveillance, Epidemiology, and End Results (SEER) database was used to identify women younger than 45 years diagnosed with stage IB1 cervical cancer from 1998 to 2012. Only those who underwent lymph node (LN) assessment were included. Outcomes of UPS versus non-UPS were analyzed.

Results Among 2717 patients, 125 were treated with UPS and 2592 were treated with non-UPS. Those in the UPS group were younger (median age 33 vs 37 years, P < 0.001), less commonly had tumor size greater than 2 cm (27% vs 45%, P < 0.001), and less commonly received adjuvant radiation therapy (18% vs 29%, P = 0.006). There was no difference in distribution of tumor grade, histology, or rate of LN positivity. Median follow-up was 79 months (range, 0–179). There was no difference in 5-year disease-specific survival (DSS) between the UPS versus non-UPS groups (93% vs 94%, respectively, P = 0.755). When stratified by tumor size, DSS for UPS versus non-UPS was as follows: tumors 2 cm or less, 96.8% versus 96.3% (P = 0.683); tumors greater than 2 cm, 82.4% versus 90.4% (P = 0.112). Factors independently associated with worsened survival included adenosquamous histology (hazard ratio [HR] 2.29, 95% confidence interval [CI]1.51–3.47), G3 disease (HR 2.44, 95% CI 1.01–5.89), tumor size greater than 2 cm (HR 1.93, 95% CI 1.36–2.75) and LN positivity (HR 2.29, 95% CI 1.64–3.22). The UPS was not associated with a higher risk of death.

Conclusions The UPS does not seem to compromise oncologic outcomes in a select group of young women with stage IB1 cervical cancer, especially in the setting of tumors 2 cm or less. Further studies are needed to clarify the role of UPS in tumors greater than 2 cm.

  • Cervical cancer
  • Stage IB1 cervical cancer
  • Uterine-preserving surgery
  • Trachelectomy
  • Oncologic outcome

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Footnotes

  • This study was supported in part through the NIH/NCI Support Grant P30 CA008748.

  • The authors declare no conflicts of interest.

  • This study was presented in part at the 16th Biennial Meeting of the International Gynecologic Cancer Society (IGCS) in Lisbon, Portugal, October 29–31, 2016.

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