[en] [en] 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.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Chacon, Enrique ; Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
Manzour, Nabil ; Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Pamplona, Navarra, Spain
Zanagnolo, Vanna; Istituto Europeo di Oncologia, Milano, Anognnn, Italy
Querleu, Denis ; Surgery, Institut Bergonie, Bordeaux, France
Núñez-Córdoba, Jorge M; Clinica Universidad de Navarra, Pamplona, Navarra, Spain
Martin-Calvo, Nerea; Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
Căpîlna, Mihai Emil; Emergency County Hospital Targu-Mures, Targu Mures, Romania
Fagotti, Anna; University Hospital Agostino Gemelli Gynaecological Oncology Complex Operative Unit, Roma, Lazio, Italy
Kucukmetin, Ali; Queen Elizabeth Hospital, Gateshead, Gateshead, UK
Mom, Constantijne; Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
Chakalova, Galina; University Oncologic Hospital, Sofia, Bulgaria
Shamistan, Aliyev; National Center of Oncology, Baku, Azerbaijan
Gil Moreno, Antonio; Gynecology, Vall d'Hebron Hospital, Sant Cugat Del Vallés, Barcelona, Spain ; Universitat Autònoma de Barcelona, Barcelona, Barcelona, Spain
Malzoni, Mario; Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
Narducci, Fabrice; Department of Gynecology, Centre Oscar Lambret, Lille, France
Arencibia, Octavio; University Maternal Hospital Canary Islands, Las Palma, Spain
Raspagliesi, Francesco; Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
Toptas, Tayfun ; Gynecologic Oncology, Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey
Cibula, David; Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
Meydanli, Mehmet Mutlu ; Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
Tavares, Mariana; IPO-PORTO, Porto, Porto, Portugal
Golub, Dmytro; Department of Surgery, LISOD-Israeli Oncological Hospital, Kyiv, Ukraine
Perrone, Anna Myriam ; Azienda Ospedaliero-Universitaria di Bologna Policlinico SantOrsola-Malpighi, Bologna, Italy
Poka, Robert ; Obstetrics and Gynecology, Unit of Gynecologic Oncology, Institute of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Tsolakidis, Dimitrios; General Hospital of Thessaloniki Papageorgiou, Thessaloniki, Central Macedonia, Greece
Vujić, Goran; Clinical Hospital Center, Zagreb, Croatia
Jedryka, Marcin A ; Oncological Gynecology, Lower Silesian Cancer Center, Wroclaw, Poland
Zusterzeel, Petra L M; Gynecological Oncology, Radboudumc, Nijmegen, Netherlands
Goffin, Frédéric ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gynécologie-obstétrique (CHR)
Haidopoulos, Dimitrios; Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
Haller, Herman; Clinical Hospital Center Rijeka, Rijeka, Croatia
Jach, Robert; Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
Yezhova, Iryna; Lviv Oncology Center, Lviv, Ukraine
Berlev, Igor; North-Western State Medical University, NN Petrov Research Institute of Oncology, Saint-Petersburg, Saint-Petersburg, Russian Federation
Bernardino, Margarida; Gynecology, Instituto Português de Oncologia de Lisboa, Lisboa, Lisboa, Portugal
Bharathan, Rasiah; University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
Lanner, Maximilian; Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Steiermark, Austria
Maenpaa, Minna M; Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
Sukhin, Vladyslav ; Oncogynecology, Grigorev Institute for Radiology, Kharkiv, Ukraine
Feron, Jean-Guillaume; Institut Curie, Paris, Île-de-France, France
Fruscio, Robert ; Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy ; Clinic of Obstetrics and Gynecology, Hospital San Gerardo, Monza, Italy
Kukk, Kersti; North Estonia Medical Centre, Tallinn, Estonia
Ponce, Jordi; Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
Minguez, Jose Angel ; Gynecology, Clinica Universitaria de Navarra, Pamplona, Navarra, Spain
Vázquez-Vicente, Daniel ; Gynecology, Clinica Universitaria de Navarra, Madrid, Spain
Castellanos, Teresa; Gynecology, Clinica Universitaria de Navarra, Madrid, Spain
Boria, Felix ; Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Madrid, Spain
Alcazar, Juan Luis ; Obstetrics and Gynecology, School of Medicine, University of Navarra, Pamplona, Spain
Chiva, Luis ; Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain lchiva@unav.es
Cibula D, Pötter R, Planchamp F, et al. The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology guidelines for the management of patients with cervical cancer. Int J Gynecol Cancer 2018;28:641–55.
Ramirez PT, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med 2018;379:1895–904.
Chiva L, Zanagnolo V, Querleu D, et al. SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer. Int J Gynecol Cancer 2020;30:1269–77.
Melamed A, Margul DJ, Chen L, et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. N Engl J Med 2018;379:1905–14.
Doo DW, Kirkland CT, Griswold LH, et al. Comparative outcomes between robotic and abdominal radical hysterectomy for IB1 cervical cancer: results from a single high volume institution. Gynecol Oncol 2019;153:242–7.
National Cancer Registration and Analysis Service (NCRAS) cervical cancer surgery analysis, 2019. Available: https://www. bgcs. org. uk/ wp- content/ uploads/ 2019/ 07/ NCRAS- cervical- cancersurgeryanalysis-May- 2019- final. pdf [Accessed 03 Jul 2020].
Kim SI, Lee M, Lee S, et al. Impact of laparoscopic radical hysterectomy on survival outcome in patients with FIGO stage Ib cervical cancer: a matching study of two institutional hospitals in Korea. Gynecol Oncol 2019;155:75–82.
Cusimano MC, Baxter NN, Gien LT, et al. Impact of surgical approach on oncologic outcomes in women undergoing radical hysterectomy for cervical cancer. Am J Obstet Gynecol 2019;221:619.e1–619.e24.
Uppal S, Gehrig P, Vetter MH, et al. Recurrence rates in cervical cancer patients treated with abdominal versus minimally invasive radical hysterectomy: a multi-institutional analysis of 700 cases. JCO 2019;37:5504–5.
Chen X, Zhao N, Ye P, et al. Comparison of laparoscopic and open radical hysterectomy in cervical cancer patients with tumor size ≤2 cm. Int J Gynecol Cancer 2020;30:564–71.
Uppal S, Gehrig PA, Peng K, et al. Recurrence rates in patients with cervical cancer treated with abdominal versus minimally invasive radical hysterectomy: a multi-institutional retrospective review study. J Clin Oncol 2020;38:1030–40.
Casarin J, Bogani G, Papadia A, et al. Preoperative conization and risk of recurrence in patients undergoing laparoscopic radical hysterectomy for early stage cervical cancer: a multicenter study. J Minim Invasive Gynecol 2021;28:117–23.
Manzour N, Chacon E, Martín-Calvo N. 258 Design and validation of a recurrence risk predicting score in early stage cervical cancer after radical hysterectomy. Int J Gynecol Cancer 2020;30.
Pecorelli S, Zigliani L, Odicino F. Revised FIGO staging for carcinoma of the cervix. Int J Gynaecol Obstet 2009;105:107–8.
Boria F, Chiva L, Zanagnolo V, et al. Radical hysterectomy in early cervical cancer in Europe: characteristics, outcomes and evaluation of ESGO quality indicators. Int J Gynecol Cancer 2021;31:1212–9.
Bizzarri N, Pedone Anchora L, Kucukmetin A, et al. Protective role of conization before radical hysterectomy in early-stage cervical cancer: a propensity-score matching study. Ann Surg Oncol 2021;28:3585–94.
Schmeler KM, Pareja R, Lopez Blanco A, et al. ConCerv: a prospective trial of conservative surgery for low-risk early-stage cervical cancer. Int J Gynecol Cancer 2021;31:1317–25.
Hutchcraft ML, Smith B, McLaughlin EM, et al. Conization pathologic features as a predictor of intermediate and high risk features on radical hysterectomy specimens in early stage cervical cancer. Gynecol Oncol 2019;153:255–8.
Martín-Calvo N, Chacón E. Can a cone biopsy predict nodal status in early cervical cancer? 22nd European Congress on Gynecological Oncology, European Society of Gynaecological Oncology, 2020.
Köhler C, Hertel H, Herrmann J, et al. Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff - a multicenter analysis. Int J Gynecol Cancer 2019;29:845–50.
