Oncological Outcomes After Okabayashi-Kobayashi Radical Hysterectomy for Early and Locally Advanced Cervical Cancer

Abstract

Importance: The role of surgery in early-stage cervical cancer has been established, but it is controversial in locally advanced cervical cancer.

Objective: To determine whether a radical hysterectomy method with extended removal of paracervical tissue for locally advanced cervical cancer is associated with satisfactory oncological outcomes.

Design, setting, and participants: This retrospective cohort study was conducted from January 1, 2002, to December 31, 2011, and participants were patients with cervical cancer at a single tertiary center in Northern Japan. The median follow-up period was 106 months, and none of the patients were lost to follow-up at less than 60 months. Data analyses were performed from July 1, 2017, to December 31, 2018.

Exposures: Patients underwent radical hysterectomy using the Okabayashi-Kobayashi method. Bilateral nerve preservation was used for stage IB1/IB2 disease and unilateral nerve preservation for stage IIA/IIB if disease extension outside the uterine cervix was 1-sided. Chemotherapy was used as the choice of adjuvant treatment for patients with an intermediate or high risk of recurrence, while some patients chose or were assigned to radiotherapy.

Main outcomes and measures: Primary outcomes were the 5-year local control rate and 5-year overall survival rate along with risk factor analysis.

Results: Of 121 consecutive patients, 76 (62.8%) had early-stage cervical cancer in 2008 International Federation of Gynecology and Obstetrics stages IB1 and IIA1 and 45 (37.2%) had locally advanced cervical cancer in stages IB2, IIA2, and IIB. The median (range) age was 42 (26-68) years. Adjuvant radiotherapy was used in 2 patients (3%) with early-stage cervical cancer and 3 (7%) of those with locally advanced cervical cancer. The 5-year local control rates for early-stage cervical cancer and locally advanced cervical cancer were 99% and 87%, respectively. The 5-year overall survival rates for early-stage cervical cancer and locally advanced cervical cancer were 95% and 82%, respectively. Cox regression analysis showed that lymph node metastasis and histology of adeno(squamous)carcinoma were independent risk factors for the overall survival of patients with cervical cancer treated with radical hysterectomy.

Conclusions and relevance: The nerve-sparing Okabayashi-Kobayashi radical hysterectomy for locally advanced cervical cancer may provide survival not inferior to radical hysterectomy or radiotherapy in published literature. The applicability of radical hysterectomy with adjuvant chemotherapy for locally advanced cervical cancer needs to be validated by prospective comparative trials.

Figure.. Oncological Outcomes in Early-Stage and Locally Advanced Cervical Cancer Treated With Nerve-Sparing Radical Hysterectomy

The cumulative incidence curve for local recurrence (A) was obtained using Gray method. Comparison of the cumulative incidence curves was achieved by the Fine-Gray proportional subdistribution hazards regression. Recurrence in the regional lymph node area and distant organs, and all-cause death were competing risks for local recurrence. Cumulative disease-free survival (B) and cumulative overall survival (C) were obtained using the Kaplan-Meier method, and the association with the Federation of Gynecology and Obstetrics stage was evaluated using the log-rank test. Hazard ratio for disease-free survival and overall survival were calculated using Cox regression analysis.