Trends in Use and Survival Associated With Fertility-Sparing Trachelectomy for Young Women With Early-Stage Cervical Cancer

Abstract

Objective: To assess the trends in use of trachelectomy in the United States and to examine the outcomes of the procedure compared with hysterectomy in young women with cervical cancer.

Methods: Data were analyzed from women younger than 50 years of age with stage IA2-IB2 cervical cancer treated with hysterectomy or trachelectomy from 2004 to 2014 who were registered in the National Cancer Database. After propensity score matching, we used Cox proportional hazard models to examine the association between treatment and survival.

Results: We identified 15,150 patients with cervical cancer, including 14,714 (97.1%) who underwent hysterectomy and 436 (2.9%) who underwent trachelectomy. Trachelectomy rates increased from 1.5% in 2004 to 3.8% by 2014 (P<.001). The greatest increase in the rate of trachelectomy was seen in women younger than 30 years of age (4.6% in 2004 to 17.0% in 2014, P<.001). Among women who underwent trachelectomy, 29.6% had tumors greater than 2 cm in diameter. In a multivariable model, younger women and those more recently diagnosed were more likely to undergo trachelectomy, whereas Medicaid recipients (risk ratio 0.39, 95% CI 0.28-0.54) and the uninsured (risk ratio 0.67, 95% CI 0.45-1.00) were less likely to undergo trachelectomy. After propensity score matching, there was no association between trachelectomy and the risk of mortality (hazard ratio 1.24, 95% CI 0.70-2.22) (mortality rate was 6.0% for hysterectomy vs 5.2% for trachelectomy). Similarly, 5-year survival rates were similar between trachelectomy and hysterectomy for all of the stages examined.

Conclusions: Use of trachelectomy for early-stage cervical cancer has increased in the United States, particularly among women younger than 30 years of age. Within this population, survival is similar for trachelectomy and hysterectomy.

Figure 1

Percentage of trachelectomy overall (A) (P<.001) and stratified by age group (B). Error bars represent 95% confidence interval (P<.001 for <30 years of age; P=.13 for 30–39 years of age, 0.13; P=.07 for 40–49 years of age). P values calculated using Cochrane-Armitage trend tests.

Figure 2

Kaplan-Meier curves of the 2:1 propensity score matched cohort overall (A) (N=1,139, trachelectomy: n=379, hysterectomy: n=76, P=.70); stage 1A2 (B) (n=109, trachelectomy: n=37, hysterectomy: n=72; P =.95); stage 1B1 (C) (n=677, trachelectomy: n=226, hysterectomy: n=451; P=.44); stage 1B not otherwise specified (D) (n=332, trachelectomy: n=108, hysterectomy: n=224; P=.81). P values derived from log-rank tests.