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Original research
SUCCOR cone study: conization before radical hysterectomy
  1. Enrique Chacon1,
  2. Nabil Manzour2,
  3. Vanna Zanagnolo3,
  4. Denis Querleu4,
  5. Jorge M Núñez-Córdoba5,
  6. Nerea Martin-Calvo6,
  7. Mihai Emil Căpîlna7,
  8. Anna Fagotti8,
  9. Ali Kucukmetin9,
  10. Constantijne Mom10,
  11. Galina Chakalova,11,
  12. Aliyev Shamistan12,
  13. Antonio Gil Moreno13,14,
  14. Mario Malzoni15,
  15. Fabrice Narducci16,
  16. Octavio Arencibia17,
  17. Francesco Raspagliesi18,
  18. Tayfun Toptas19,
  19. David Cibula20,
  20. Dilyara Kaidarova21,
  21. Mehmet Mutlu Meydanli22,
  22. Mariana Tavares23,
  23. Dmytro Golub24,
  24. Anna Myriam Perrone25,
  25. Robert Poka26,
  26. Dimitrios Tsolakidis27,
  27. Goran Vujić28,
  28. Marcin A Jedryka29,
  29. Petra L M Zusterzeel30,
  30. Jogchum Jan Beltman31,
  31. Frederic Goffin32,
  32. Dimitrios Haidopoulos33,
  33. Herman Haller34,
  34. Robert Jach35,
  35. Iryna Yezhova36,
  36. Igor Berlev37,
  37. Margarida Bernardino38,
  38. Rasiah Bharathan39,
  39. Maximilian Lanner40,
  40. Minna M Maenpaa41,
  41. Vladyslav Sukhin42,
  42. Jean-Guillaume Feron43,
  43. Robert Fruscio44,45,
  44. Kersti Kukk46,
  45. Jordi Ponce47,
  46. Jose Angel Minguez48,
  47. Daniel Vázquez-Vicente49,
  48. Teresa Castellanos49,
  49. Felix Boria50,
  50. Juan Luis Alcazar51 and
  51. Luis Chiva52
  52. The SUCCOR study group
    1. 1Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
    2. 2Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Pamplona, Navarra, Spain
    3. 3Istituto Europeo di Oncologia, Milano, Anognnn, Italy
    4. 4Surgery, Institut Bergonie, Bordeaux, France
    5. 5Clinica Universidad de Navarra, Pamplona, Navarra, Spain
    6. 6Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
    7. 7Emergency County Hospital Targu-Mures, Targu Mures, Romania
    8. 8University Hospital Agostino Gemelli Gynaecological Oncology Complex Operative Unit, Roma, Lazio, Italy
    9. 9Queen Elizabeth Hospital, Gateshead, Gateshead, UK
    10. 10Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
    11. 11University Oncologic Hospital, Sofia, Bulgaria
    12. 12National Center of Oncology, Baku, Azerbaijan
    13. 13Gynecology, Vall d'Hebron Hospital, Sant Cugat Del Vallés, Barcelona, Spain
    14. 14Universitat Autònoma de Barcelona, Barcelona, Barcelona, Spain
    15. 15Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
    16. 16Department of Gynecology, Centre Oscar Lambret, Lille, France
    17. 17University Maternal Hospital Canary Islands, Las Palma, Spain
    18. 18Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
    19. 19Gynecologic Oncology, Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey
    20. 20Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
    21. 21Oncogynecology, Kazahskij Naucno-issledovatel'skij Institut Onkologii i Radiologii, Almaty, Kazakhstan
    22. 22Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
    23. 23IPO-PORTO, Porto, Porto, Portugal
    24. 24Department of Surgery, LISOD-Israeli Oncological Hospital, Kyiv, Ukraine
    25. 25Azienda Ospedaliero-Universitaria di Bologna Policlinico SantOrsola-Malpighi, Bologna, Italy
    26. 26Obstetrics and Gynecology, Unit of Gynecologic Oncology, Institute of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
    27. 27General Hospital of Thessaloniki Papageorgiou, Thessaloniki, Central Macedonia, Greece
    28. 28Clinical Hospital Center, Zagreb, Croatia
    29. 29Oncological Gynecology, Lower Silesian Cancer Center, Wroclaw, Poland
    30. 30Gynecological Oncology, Radboudumc, Nijmegen, Netherlands
    31. 31Gynaecology, LUMC, Leiden, Netherlands
    32. 32Obstetrics and Gynecology, University of Liege, Liege, Belgium
    33. 33Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
    34. 34Clinical Hospital Center Rijeka, Rijeka, Croatia
    35. 35Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
    36. 36Lviv Oncology Center, Lviv, Ukraine
    37. 37North-Western State Medical University, NN Petrov Research Institute of Oncology, Saint-Petersburg, Saint-Petersburg, Russian Federation
    38. 38Gynecology, Instituto Português de Oncologia de Lisboa, Lisboa, Lisboa, Portugal
    39. 39University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
    40. 40Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Steiermark, Austria
    41. 41Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
    42. 42Oncogynecology, Grigorev Institute for Radiology, Kharkiv, Ukraine
    43. 43Institut Curie, Paris, Île-de-France, France
    44. 44Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
    45. 45Clinic of Obstetrics and Gynecology, Hospital San Gerardo, Monza, Italy
    46. 46North Estonia Medical Centre, Tallinn, Estonia
    47. 47Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
    48. 48Gynecology, Clinica Universitaria de Navarra, Pamplona, Navarra, Spain
    49. 49Gynecology, Clinica Universitaria de Navarra, Madrid, Spain
    50. 50Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Madrid, Spain
    51. 51Obstetrics and Gynecology, School of Medicine, University of Navarra, Pamplona, Spain
    52. 52Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
    1. Correspondence to Dr Luis Chiva, Obstetrics and Gynecology, Clinica Universidad de Navarra, MADRID, Spain; lchiva{at}unav.es

    Abstract

    Objective To evaluate disease-free survival of cervical conization prior to radical hysterectomy in patients with stage IB1 cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009).

    Methods A multicenter retrospective observational cohort study was conducted including patients from the Surgery in Cervical Cancer Comparing Different Surgical Aproaches in Stage IB1 Cervical Cancer (SUCCOR) database with FIGO 2009 IB1 cervical carcinoma treated with radical hysterectomy between January 1, 2013, and December 31, 2014. We used propensity score matching to minimize the potential allocation biases arising from the retrospective design. Patients who underwent conization but were similar for other measured characteristics were matched 1:1 to patients from the non-cone group using a caliper width ≤0.2 standard deviations of the logit odds of the estimated propensity score.

    Results We obtained a weighted cohort of 374 patients (187 patients with prior conization and 187 non-conization patients). We found a 65% reduction in the risk of relapse for patients who had cervical conization prior to radical hysterectomy (hazard ratio (HR) 0.35, 95% confidence interval (CI) 0.16 to 0.75, p=0.007) and a 75% reduction in the risk of death for the same sample (HR 0.25, 95% CI 0.07 to 0.90, p=0.033). In addition, patients who underwent minimally invasive surgery without prior conization had a 5.63 times higher chance of relapse compared with those who had an open approach and previous conization (HR 5.63, 95% CI 1.64 to 19.3, p=0.006). Patients who underwent minimally invasive surgery with prior conization and those who underwent open surgery without prior conization showed no differences in relapse rates compared with those who underwent open surgery with prior cone biopsy (reference) (HR 1.94, 95% CI 0.49 to 7.76, p=0.349 and HR 2.94, 95% CI 0.80 to 10.86, p=0.106 respectively).

    Conclusions In this retrospective study, patients undergoing cervical conization before radical hysterectomy had a significantly lower risk of relapse and death.

    • cervical cancer
    • surgery
    • hysterectomy
    • laparoscopes
    • laparotomy

    Data availability statement

    Data are available upon reasonable request. Data is available upon request. Please contact the corresponding author.

    https://doi.org/10.1136/ijgc-2021-002544

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      Data availability statement

      Data are available upon reasonable request. Data is available upon request. Please contact the corresponding author.

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      Footnotes

      • Twitter @Quique_ChC, @r.bolatbekova@gmail.com, @RasiahBharathan, @BoriaFelix, @Juan_L_Alcazar

      • Collaborators On behalf of the SUCCOR study group: Nabil Abdalla, Sedat Akgöl, Demirkiran Aksahin, Shamistan Aliyev, Maria Alonso-Espias, Igor Aluloski, Claudia Andrade, Nikola Badzakov, Rosa Barrachina, Giorgio Bogani, Eduard-Aexandru Bonci, Hélène Bonsang-Kitzis, Cosima Brucker, Laura Cárdenas, Andrea Casajuana, Pere Cavalle, Jorge Cea, Benito Chiofalo, Gloria Cordeiro, Pluvio Coronado, Maria Cuadra, Javier Díez, Teresa Diniz da Costa, Santiago Domingo, Lukas Dostalek, Fuat Elif, Diego Erasun, Mathias Fehr, Sergi Fernandez-Gonzalez,Annamaria Ferrero, Soledad Fidalgo, Gabriel Fiol, Khadra Galaal, José García, Gerhard Gebauer, Fabio Ghezzi, Juan Gilabert, Nana Gomes, Elisabete Gonçalves, Virginia Gonzalez, Frederic Grandjean, Miriam Guijarro, Frédéric Guyon, Jolien Haesen, Gines Hernandez-Cortes, Sofía Herrero, Imre Pete, Ioannis Kalogiannidis, Erbil Karaman, Andreas Kavallaris, Lukasz Klasa, Ioannis Kotsopoulos, Stefan Kovachev, Uppin Arno Leht, Arantxa Lekuona, Mathieu Luyckx, Michael Mallmann, Gemma Mancebo, Aljosa Mandic, Tiermes Marina, Victor Martin, María Belén Martín-Salamanca, Víctor Lago, Alejandra Martinez, Gesine Meili, Gustavo Mendinhos, Liliana Mereu, Milena Mitrovic, Sara Morales, Enrique Moratalla, Natalia R. Gómez-Hidalgo, Bibiana Morillas, Eva Myriokefalitaki, Maja PakižImre, Imre Pete, Stamatios Petousis, Laurentiu Pirtea, Natalia Povolotskaya, Sonia Prader, Alfonso Quesada, Mikuláš Redecha, Fernando Roldan, Philip Rolland, Reeli Saaron, Cosmin-Paul Sarac, Jens-Peter Scharf, Špela Smrkolj, Rita Sousa, Artem Stepanyan, Vladimír Študent, Carmen Tauste, Hans Trum, Taner Turan, Manuela Undurraga, Alicia Vázquez, Ignace Vergote, George Vorgias, and Ignacio Zapardiel.

      • Contributors All authors contributed meaningfully to the conception or design of the work or the acquisition, analysis, or interpretation of data for the study. The authors confirm the completeness and accuracy of the data and analyses, the fidelity of the study to the protocol, and the final approval of the version to be published. LCH is responsible for the overall content as the guarantor.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

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