TY - JOUR
T1 - Fertility-sparing trachelectomy for early-stage cervical cancer
T2 - A proposal of an ideal candidate
AU - Machida, Hiroko
AU - Iwata, Takashi
AU - Okugawa, Kaoru
AU - Matsuo, Koji
AU - Saito, Tsuyoshi
AU - Tanaka, Kyoko
AU - Morishige, Kenichiro
AU - Kobayashi, Hiroaki
AU - Yoshino, Kiyoshi
AU - Tokunaga, Hideki
AU - Ikeda, Tomoaki
AU - Shozu, Makio
AU - Yaegashi, Nobuo
AU - Enomoto, Takayuki
AU - Mikami, Mikio
N1 - Funding Information:
We thank all the Japanese Gynecologic Oncology Group participating sites for this study. Especially, Keio University School of Medicine, Kyushu University School of Medicine, Kitano Hospital, Sapporo medical University, Osaka University Graduate School of Medicine, Tohoku University, Kyoto Prefectural University of Medicine, Hyogo Cancer Center, University of The Ryukyus, Osaka International Cancer Institute, Niigata University School of Medicine, Gifu University Graduate School of Medicine, Yamagata University, Fukushima Medical University Hospital, Kanazawa University, Ehime University, Teikyo University, Akita University Graduate School of Medicine, and Yamaguchi University Graduate School of Medicine.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/2
Y1 - 2020/2
N2 - Objective: To propose an ideal patient candidate with early-stage cervical cancer for undergoing fertility-sparing trachelectomy. Methods: This nationwide, multicenter, retrospective study was conducted by the Japan Society of Obstetrics and Gynecology involving women aged <45 years with clinical stage I-II cervical cancer who had planned fertility-sparing trachelectomy and pelvic lymphadenectomy between 2009 and 2013 (n = 393). Ideal candidates were defined to have a tumor size of ≤2 cm, no lymph node metastasis, no deep stromal invasion, and no high-risk histology (n = 284, 69.6%). Less-ideal candidates were defined to have any one of these four characteristics (n = 109, 30.4%). Propensity score inverse probability of treatment weighting was used to assess survival outcomes. Results: Less-ideal candidates were more likely to undergo hysterectomy conversion (22.9% versus 3.2%), receive postoperative radiotherapy (11.9% versus 0.4%), or chemotherapy (32.1% versus 3.2%) compared with ideal candidates (all, P < 0.05). The weighted model revealed that among those who underwent trachelectomy (ideal candidates, n = 275 and less-ideal candidates, n = 84), less-ideal candidates had significantly decreased disease-free survival (5-year rates: 85.5% versus 95.5%; HR 3.93, 95% CI 1.99–7.74; P < 0.001) and cause-specific survival (92.5% versus 98.6%; HR 5.47, 95% CI 1.68–17.8, P = 0.001) compared with ideal candidates. Similarly, less-ideal candidates were significantly associated with decreased disease-free survival compared with ideal candidates among those who were young age, had small tumors or squamous histology, and underwent surgery alone (all, P < 0.05). Conclusion: Less-ideal candidates had approximately four-fold higher recurrence risk and cancer mortality compared with ideal candidates. Ideal candidates for fertility-sparing trachelectomy for early-stage cervical cancer proposed in our study may be useful as the future framework for developing guidelines for fertility-sparing trachelectomy in Japan.
AB - Objective: To propose an ideal patient candidate with early-stage cervical cancer for undergoing fertility-sparing trachelectomy. Methods: This nationwide, multicenter, retrospective study was conducted by the Japan Society of Obstetrics and Gynecology involving women aged <45 years with clinical stage I-II cervical cancer who had planned fertility-sparing trachelectomy and pelvic lymphadenectomy between 2009 and 2013 (n = 393). Ideal candidates were defined to have a tumor size of ≤2 cm, no lymph node metastasis, no deep stromal invasion, and no high-risk histology (n = 284, 69.6%). Less-ideal candidates were defined to have any one of these four characteristics (n = 109, 30.4%). Propensity score inverse probability of treatment weighting was used to assess survival outcomes. Results: Less-ideal candidates were more likely to undergo hysterectomy conversion (22.9% versus 3.2%), receive postoperative radiotherapy (11.9% versus 0.4%), or chemotherapy (32.1% versus 3.2%) compared with ideal candidates (all, P < 0.05). The weighted model revealed that among those who underwent trachelectomy (ideal candidates, n = 275 and less-ideal candidates, n = 84), less-ideal candidates had significantly decreased disease-free survival (5-year rates: 85.5% versus 95.5%; HR 3.93, 95% CI 1.99–7.74; P < 0.001) and cause-specific survival (92.5% versus 98.6%; HR 5.47, 95% CI 1.68–17.8, P = 0.001) compared with ideal candidates. Similarly, less-ideal candidates were significantly associated with decreased disease-free survival compared with ideal candidates among those who were young age, had small tumors or squamous histology, and underwent surgery alone (all, P < 0.05). Conclusion: Less-ideal candidates had approximately four-fold higher recurrence risk and cancer mortality compared with ideal candidates. Ideal candidates for fertility-sparing trachelectomy for early-stage cervical cancer proposed in our study may be useful as the future framework for developing guidelines for fertility-sparing trachelectomy in Japan.
KW - Cervical cancer
KW - Deep stromal invasion
KW - Lymph node metastasis
KW - Survival
KW - Trachelectomy
KW - Tumor size
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U2 - 10.1016/j.ygyno.2019.11.021
DO - 10.1016/j.ygyno.2019.11.021
M3 - Article
C2 - 31767188
AN - SCOPUS:85075898596
VL - 156
SP - 341
EP - 348
JO - Gynecologic Oncology
JF - Gynecologic Oncology
SN - 0090-8258
IS - 2
ER -