Introduction/Background The aim of this study was to assess whether increased radicality had an impact on 5-year disease-free survival (DFS) in patients with early-stage cervical cancer undergoing radical hysterectomy. Secondary aims were 5-year overall survival (OS) and pattern of recurrence.
Methodology International, multicenter, retrospective study from the Surveillance in Cervical CANcer (SCCAN) collaborative cohort. Patients with FIGO-2009 stage IB1-IIA1 who underwent open type B/C1/C2 radical hysterectomy according to Querleu-Morrow classification between 01/2007–12/2016, who did not undergo neo-adjuvant chemotherapy and who had negative lymph nodes and free surgical margins at final histology, were included.
Results 1,257 patients were included. 883 (70.2%) underwent nerve sparing and 374 (29.8%) non-nerve sparing radical hysterectomy. 5-year-DFS in patients undergoing nerve sparing versus non-nerve sparing radical hysterectomy was 90.1% (95%CI:87.9–92.2) versus 93.8% (95%CI:91.1–96.5), p=0.047, respectively. Non-nerve sparing radical hysterectomy was independently associated with better DFS at multivariable analysis performed on the entire cohort (HR:0.50,95%CI:0.31–0.81;p=0.004). 5-year-OS was: nerve-sparing 95.7% (95%CI:94.1–97.2) versus non-nerve sparing 96.5% (95%CI:94.3–98.7), p=0.78. In patients with tumor diameter ≤20mm 5-year-DFS was 94.7% in nerve sparing versus 96.2% in non-nerve sparing (p=0.22). 5-year-DFS was 90.3% in non-nerve sparing radical hysterectomy compared with 83.1% in nerve sparing radical hysterectomy (p=0.016) in patients with tumors between 21–40mm (no significant difference in rate of adjuvant treatment in this subgroup, p=0.47). Significant DFS difference was confirmed after propensity match score analysis (balancing the two study groups). Pattern of recurrence in the propensity matched population did not demonstrate any difference (p=0.70).
Conclusion For tumors ≤20mm no survival difference was found with more radical hysterectomy. For tumors between 21–40mm a more radical hysterectomy was associated with improved 5-year-DFS. No difference in pattern of recurrence according to extent of radicality was observed. Non-nerve sparing radical hysterectomy was associated with better 5-year-DFS compared with nerve-sparing radical hysterectomy after propensity score match analysis.
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