Hiroko Machida1, Takashi Iwata2, Kaoru Okugawa3, Koji Matsuo4, Tsuyoshi Saito5, Kyoko Tanaka2, Kenichiro Morishige6, Hiroaki Kobayashi7, Kiyoshi Yoshino8, Hideki Tokunaga9, Tomoaki Ikeda10, Makio Shozu11, Nobuo Yaegashi9, Takayuki Enomoto12, Mikio Mikami13. 1. Department of Obstetrics and Gynecology, Tokai University School of Medicine, Japan. 2. Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan. 3. Department of Obstetrics and Gynecology, Kyushu University School of Medicine, Japan. 4. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, USA; Norris Comprehensive Cancer Center, University of Southern California, USA. 5. Department of Obstetrics and Gynecology, Sapporo Medical University, Japan. 6. Department of Obstetrics and Gynecology, Gifu University Graduate School of Medicine, Japan. 7. Department of Obstetrics and Gynecology, Kagoshima University, Japan. 8. Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Japan. 9. Department of Obstetrics and Gynecology, Tohoku University, Japan. 10. Department of Obstetrics and Gynecology, Mie University, Japan. 11. Department of Obstetrics and Gynecology, Chiba University, Japan. 12. Department of Obstetrics and Gynecology, Niigata University School of Medicine, Japan. 13. Department of Obstetrics and Gynecology, Tokai University School of Medicine, Japan. Electronic address: mmikami@is.icc.u-tokai.ac.jp.
Abstract
OBJECTIVE: To propose an ideal patient candidate with early-stage cervical cancer for undergoing fertility-sparing trachelectomy. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
OBJECTIVE: To propose an ideal patient candidate with early-stage cervical cancer for undergoing fertility-sparing trachelectomy. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
Authors: Lori Spoozak; Sharyn N Lewin; William M Burke; Israel Deutsch; Xuming Sun; Thomas J Herzog; Jason D Wright Journal: Am J Obstet Gynecol Date: 2011-07-22 Impact factor: 8.661
Authors: Jason D Wright; Ruvandhi Nathavithrana; Sharyn N Lewin; Xuming Sun; Israel Deutsch; William M Burke; Thomas J Herzog Journal: Obstet Gynecol Date: 2010-03 Impact factor: 7.661