Hiroko Machida1, Rachel S Mandelbaum2, Mikio Mikami1, Takayuki Enomoto3, Yukio Sonoda4, Brendan H Grubbs5, Richard J Paulson6, Lynda D Roman7, Jason D Wright8, Koji Matsuo9. 1. Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan. 2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA. 3. Department of Obstetrics and Gynecology, Niigata University School of Medicine, Niigata, Japan. 4. Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. 5. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA. 6. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA. 7. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA. 8. Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY. 9. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA. Electronic address: koji.matsuo@med.usc.edu.
Abstract
BACKGROUND: Trachelectomy is the treatment of choice for reproductive-aged women with early-stage cervical cancer who desire future fertility. Comprehensive population-based statistics have been missing to date. OBJECTIVE: We sought to compare characteristics and survival of reproductive-aged women who underwent trachelectomy for early-stage cervical cancer to those who had hysterectomy. STUDY DESIGN: This is a retrospective observational study examining the Surveillance, Epidemiology, and End Results program from 1998 through 2014. Women <45 years of age with stage IA and IB1 (tumor size ≤2 cm) cervical cancer who underwent trachelectomy were compared to those who underwent hysterectomy. Multivariable models were used to identify clinicopathological factors associated with trachelectomy. Survival was compared between the 2 groups after propensity score matching. RESULTS: Among 6359 women, 190 (3.0%; 95% confidence interval, 2.6-3.4) underwent trachelectomy. The median age of the trachelectomy group was 31 years (interquartile range, 28-34). The proportion of women who underwent trachelectomy significantly increased during the study period (1.2% in 1998 through 2002, 3.0% in 2003 through 2008, and 4.5% in 2009 through 2014, P < .001). Younger age, nonblack race, single marital status, eastern registry area, recent disease diagnosis, nonsquamous histology, and higher stage were independent factors associated with trachelectomy use (all, adjusted P < .05). After propensity score matching, 5-year cause-specific survival (96.9% vs 96.6%; hazard ratio, 0.73; 95% confidence interval, 0.23-2.30; P = .59) and overall survival (96.1% vs 96.6%; hazard ratio, 0.76; 95% confidence interval, 0.26-2.20; P = .61) were similar between the trachelectomy group and the hysterectomy group. CONCLUSION: Our study found that there was a significant increase in the proportion of reproductive-aged women with stage IA or IB1 (≤2 cm) cervical cancer who underwent trachelectomy in recent years. Survival with trachelectomy was similar to those who had hysterectomy in this population.
BACKGROUND: Trachelectomy is the treatment of choice for reproductive-aged women with early-stage cervical cancer who desire future fertility. Comprehensive population-based statistics have been missing to date. OBJECTIVE: We sought to compare characteristics and survival of reproductive-aged women who underwent trachelectomy for early-stage cervical cancer to those who had hysterectomy. STUDY DESIGN: This is a retrospective observational study examining the Surveillance, Epidemiology, and End Results program from 1998 through 2014. Women <45 years of age with stage IA and IB1 (tumor size ≤2 cm) cervical cancer who underwent trachelectomy were compared to those who underwent hysterectomy. Multivariable models were used to identify clinicopathological factors associated with trachelectomy. Survival was compared between the 2 groups after propensity score matching. RESULTS: Among 6359 women, 190 (3.0%; 95% confidence interval, 2.6-3.4) underwent trachelectomy. The median age of the trachelectomy group was 31 years (interquartile range, 28-34). The proportion of women who underwent trachelectomy significantly increased during the study period (1.2% in 1998 through 2002, 3.0% in 2003 through 2008, and 4.5% in 2009 through 2014, P < .001). Younger age, nonblack race, single marital status, eastern registry area, recent disease diagnosis, nonsquamous histology, and higher stage were independent factors associated with trachelectomy use (all, adjusted P < .05). After propensity score matching, 5-year cause-specific survival (96.9% vs 96.6%; hazard ratio, 0.73; 95% confidence interval, 0.23-2.30; P = .59) and overall survival (96.1% vs 96.6%; hazard ratio, 0.76; 95% confidence interval, 0.26-2.20; P = .61) were similar between the trachelectomy group and the hysterectomy group. CONCLUSION: Our study found that there was a significant increase in the proportion of reproductive-aged women with stage IA or IB1 (≤2 cm) cervical cancer who underwent trachelectomy in recent years. Survival with trachelectomy was similar to those who had hysterectomy in this population.
Authors: René Pareja; Gabriel J Rendón; Carlos Millán Sanz-Lomana; Otto Monzón; Pedro T Ramirez Journal: Gynecol Oncol Date: 2013-06-14 Impact factor: 5.482
Authors: Hiroko Machida; Erin A Blake; Sarah E Eckhardt; Tsuyoshi Takiuchi; Brendan H Grubbs; Mikio Mikami; Lynda D Roman; Koji Matsuo Journal: J Gynecol Oncol Date: 2017-12-27 Impact factor: 4.401
Authors: Koji Matsuo; Shinya Matsuzaki; Rachel S Mandelbaum; Kazuhide Matsushima; Maximilian Klar; Brendan H Grubbs; Lynda D Roman; Jason D Wright Journal: Gynecol Oncol Date: 2020-01-22 Impact factor: 5.482
Authors: Roni Nitecki; Jessica Floyd; Kelly Lamiman; Mark A Clapp; Shuangshuang Fu; Kirsten Jorgensen; Alexander Melamed; Paula C Brady; Anjali Kaimal; Marcela G Del Carmen; Terri L Woodard; Larissa A Meyer; Sharon H Giordano; Pedro T Ramirez; J Alejandro Rauh-Hain Journal: Obstet Gynecol Date: 2021-10-01 Impact factor: 7.623