Fertility-sparing trachelectomy for early-stage cervical cancer: A proposal of an ideal candidate.
Cervical cancer
Deep stromal invasion
Lymph node metastasis
Survival
Trachelectomy
Tumor size
Journal
Gynecologic oncology
ISSN: 1095-6859
Titre abrégé: Gynecol Oncol
Pays: United States
ID NLM: 0365304
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
received:
02
10
2019
revised:
13
11
2019
accepted:
16
11
2019
pubmed:
27
11
2019
medline:
6
5
2020
entrez:
27
11
2019
Statut:
ppublish
Résumé
To propose an ideal patient candidate with early-stage cervical cancer for undergoing fertility-sparing trachelectomy. 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. 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). 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.
Identifiants
pubmed: 31767188
pii: S0090-8258(19)31672-5
doi: 10.1016/j.ygyno.2019.11.021
pmc: PMC7526083
mid: NIHMS1627176
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
341-348Subventions
Organisme : NCI NIH HHS
ID : P30 CA014089
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
Références
Am J Clin Oncol. 2009 Aug;32(4):411-6
pubmed: 19451800
Obstet Gynecol. 2010 Mar;115(3):585-90
pubmed: 20177290
Cancer. 2018 Mar 1;124(5):943-951
pubmed: 29211304
BMJ. 2007 Oct 20;335(7624):806-8
pubmed: 17947786
Am J Epidemiol. 1999 Aug 15;150(4):327-33
pubmed: 10453808
Int J Cancer. 2017 Sep 1;141(5):1042-1051
pubmed: 28524247
Gynecol Oncol. 1999 May;73(2):177-83
pubmed: 10329031
Ann Oncol. 2011 Jan;22(1):59-67
pubmed: 20595451
Am J Obstet Gynecol. 2012 Jan;206(1):80.e1-6
pubmed: 21939955
Curr Oncol Rep. 2015;17(5):446
pubmed: 25893880
Stat Med. 2015 Dec 10;34(28):3661-79
pubmed: 26238958
Mol Clin Oncol. 2013 Jul;1(4):780-784
pubmed: 24649246
Int J Gynecol Cancer. 2013 Jul;23(6):1092-8
pubmed: 23714706
Gynecol Oncol. 2004 Apr;93(1):27-33
pubmed: 15047210
J Womens Health (Larchmt). 2015 Oct;24(10):812-8
pubmed: 26075731
Lancet Oncol. 2008 Mar;9(3):297-303
pubmed: 18308255
Obstet Gynecol. 2018 Jun;131(6):1085-1094
pubmed: 29742670
Am J Obstet Gynecol. 2019 May;220(5):469.e1-469.e13
pubmed: 30802438
Int J Clin Oncol. 2019 Jan;24(1):1-19
pubmed: 30291468
Gynecol Oncol. 2019 Apr;153(1):13-19
pubmed: 30709650
Oncotarget. 2017 Nov 15;8(63):106866-106875
pubmed: 29290995
J Clin Oncol. 2000 Apr;18(8):1606-13
pubmed: 10764420
N Engl J Med. 2018 Nov 15;379(20):1905-1914
pubmed: 30379613
Am J Obstet Gynecol. 2018 Nov;219(5):461.e1-461.e18
pubmed: 30138618
J Gynecol Oncol. 2018 Nov;29(6):e85
pubmed: 30207094
Gynecol Oncol. 2005 Mar;96(3):721-8
pubmed: 15721417
Int J Gynaecol Obstet. 2018 Oct;143 Suppl 2:22-36
pubmed: 30306584
N Engl J Med. 2018 Nov 15;379(20):1895-1904
pubmed: 30380365
Gynecol Oncol. 2013 Oct;131(1):87-92
pubmed: 23872192