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. 2018 Jul;150(1):44-49.
doi: 10.1016/j.ygyno.2018.04.571.

Less versus more radical surgery in stage IB1 cervical cancer: A population-based study of long-term survival

Jill H Tseng  1 , Alessia Aloisi  1 , Yukio Sonoda  1 , Ginger J Gardner  1 , Oliver Zivanovic  1 , Nadeem R Abu-Rustum  1 , Mario M Leitao Jr  2
Affiliations

Less versus more radical surgery in stage IB1 cervical cancer: A population-based study of long-term survival

Jill H Tseng et al. Gynecol Oncol. 2018 Jul.

Abstract

Background: Standard surgical treatment for women with stage IB1 cervical cancer consists of radical hysterectomy. This study assesses survival outcomes of those treated with less radical surgery (LRS; conization, trachelectomy, simple hysterectomy) compared to more radical surgery (MRS; modified radical, radical hysterectomy).

Methods: Using the Surveillance, Epidemiology and End Results database, we identified women <45 years with FIGO stage IB1 cervical cancer diagnosed from 1/1998 to 12/2012. Only those who underwent lymph node (LN) assessment were analyzed. Disease-specific survivals (DSSs) of LRS were compared with those of MRS.

Results: Of 2571 patients, 807 underwent LRS and 1764 underwent MRS, all with LN assessment. For LRS vs. MRS, 28% vs. 23% were diagnosed with adenocarcinoma (p = 0.024), 31% vs. 39% had G3 disease (p < 0.001), 40% vs. 45% had tumor size >2 cm (p < 0.001), and 27% vs. 29% received adjuvant radiation therapy (p = 0.005). Median follow-up was 79 months (range, 0-179). Ten-year DSS for LRS vs. MRS was 93.5% vs. 92.3% (p = 0.511). There was no difference in 10-year DSS when stratified by tumor size ≤2 cm (LRS 95.1% vs. MRS 95.6%, p = 0.80) or > 2 cm (LRS 90.1% vs. MRS 88.2%, p = 0.48). Factors independently associated with increased risk of death included adenosquamous histology (HR 2.37), G3 disease (HR 2.86), tumors >2 cm (HR 1.82), and LN positivity (HR 2.42). Compared to MRS, LRS was not associated with a higher risk of death.

Conclusions: In a select group of young women with stage IB1 cervical cancer, LRS compared to MRS does not appear to compromise DSS.

Keywords: Cervical cancer; Conization; Disease-specific survival; Radical hysterectomy; Simple hysterectomy; Trachelectomy.

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Conflict of interest statement

Conflict of Interest Statement: The authors declare that there are no conflicts of interest.

Figures

Figure 1.
Figure 1.
10-year DSS for (A) LRS vs. MRS, (B) LRS vs. MRS in patients with tumors ≤2 cm, (C) LRS vs. MRS in patients with tumors >2 cm, (D) LRS vs. MRS in patients who did not receive adjuvant RT. Abbreviations: DSS, disease-specific survival; LRS, less radical surgery; MRS, more radical surgery; RT, radiotherapy.
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