You are here

  • Home
  • Online First
  • Fertility-sparing treatment with conization versus radical hysterectomy in patients with early-stage cervical cancer: inverse propensity score weighted analysis

Article Text

Article menu
Download PDFPDF
Original research
Fertility-sparing treatment with conization versus radical hysterectomy in patients with early-stage cervical cancer: inverse propensity score weighted analysis
  1. Antonino Ditto1,
  2. Fabio Martinelli1,2,
  3. Marco Dri1,
  4. Umberto Leone Roberti Maggiore1,
  5. Giorgio Bogani1,
  6. Shigeky Kusamura3,
  7. Biagio Paolini4,
  8. Edgardo Somigliana5 and
  9. Francesco Raspagliesi1
    1. 1Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
    2. 2Gynecologic Oncology Surgical Division, Humanitas San Pio X, Milan, Italy
    3. 3Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
    4. 4Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
    5. 5Department of Gynecology and Obstetrics, Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
    1. Correspondence to Dr Antonino Ditto; antonino.ditto{at}istitutotumori.mi.it

    Abstract

    Objective To report 20 years of experience with fertility-sparing surgery for patients with early-stage cervical cancer, comparing the oncological outcomes with outcomes for those who underwent a radical hysterectomy.

    Methods Patients with pre-operative stage IA1 with lymphovascular space invasion, IA2 and IB1 cervical cancer (any grade) were included (2018 International Federation of Gynecology and Obstetrics staging system). Inclusion criteria comprised age (18–44 years), histology (squamous, adenocarcinoma, or adenosquamous) and absence of previous/concomitant cancer. A thorough counseling about oncological and obstetrical potential risks was mandatory for patients asking for fertility sparing. Results for consecutive patients who underwent fertility-sparing surgery (cervical conization and nodal evaluation) were analyzed and compared with results for patients treated with radical surgery. Oncological outcomes were assessed with a propensity score adjustment with inverse probability of treatment weighting.

    Results Overall, 109 patients were included in the study. Ten patients abandoned the fertility-sparing route because of nodal involvement (n=5), margin positive (n=2), or because patients requested radical treatment (n=3). Sentinel node mapping was performed in 19 of 49 (38.8%) patients in the fertility-sparing surgery group. Among the patients in the fertility-sparing group, 6 (12.2%) patients relapsed. 34 (69.4%) patients attempted to conceive. Pre-operative covariates selected to define the probability of having either fertility-sparing or radical surgery were well balanced using inverse probability of treatment weighting. Pathological features were similar between the groups, including grading, histotype, stage, and lymphovascular space invasion. After a median follow-up of 38.8 (range 5–186) months there were no differences in progression-free survival (p=0.32) and overall survival (p=0.74) between the fertility-sparing and radical hysterectomy groups. The results after inverse probability of treatment weighting adjustment did not show significant differences in progression-free survival (p=0.72) and overall survival (p=0.71) between the groups.

    Conclusion Fertility-sparing surgery based on conization plus laparoscopic lymph node evaluation, may be considered safe and effective for patients with early-stage cervical cancer.

    • Cervical Cancer
    • Lymph Nodes
    • Hysterectomy

    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Data are available upon reasonable request (dittotony@hotmail.com).

    https://doi.org/10.1136/ijgc-2024-005418

    Statistics from Altmetric.com

      Request Permissions

      If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

      Data availability statement

      Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Data are available upon reasonable request (dittotony@hotmail.com).

      View Full Text

      Footnotes

      • X @DrFMartinelli

      • Contributors AD: guarantor, conceptualization, data curation, formal analysis, investigation, methodology, supervision, validation, visualization, writing - original draft, writing- review and editing. FM: conceptualization, investigation, methodology, project administration, writing - review and editing. SK: conceptualization, investigation, methodology, writing - review and editing. BP: conceptualization, data curation, validation. ES: conceptualization, methodology, validation, visualization, data curation. ULRM: conceptualization, investigation, methodology, writing - review and editing. GB: data curation, formal analysis, validation, visualization, writing - review and editing. MD: conceptualization, acquisition, investigation, methodology, writing - review and editing. FR: conceptualization, investigation, methodology, writing - review and editing. AD is 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 ES has received honoraria from Ibsa and Gedeon Richter. He also handles grants of research from Ferring and Ibsa.

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