Takashi Iwata1, Hiroko Machida2, Koji Matsuo3, Kaoru Okugawa4, 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, Keio University School of Medicine, Tokyo, Japan. 2. Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan. 3. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California. 4. Department of Obstetrics and Gynecology, Kyushu University School of Medicine, Fukuoka, Japan. 5. Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan. 6. Department of Obstetrics and Gynecology, Gifu University Graduate School of Medicine, Gifu, Japan. 7. Department of Obstetrics and Gynecology, Kagoshima University, Kagoshima, Japan. 8. Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Fukuoka, Japan. 9. Department of Obstetrics and Gynecology, Tohoku University, Sendai, Japan. 10. Department of Obstetrics and Gynecology, Mie University, Tsu, Japan. 11. Department of Obstetrics and Gynecology, Chiba University, Chiba, Japan. 12. Department of Obstetrics and Gynecology, Niigata University School of Medicine, Niigata, Japan. 13. Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan. Electronic address: mmikami@is.icc.u-tokai.ac.jp.
Abstract
OBJECTIVE: To evaluate timing and a prediction model for pregnancy in early-stage cervical cancer patients who underwent fertility-sparing trachelectomy. DESIGN: Retrospective cohort. SETTING: Academic multicenter. PATIENT(S): Women ages <45 years with clinical stage I-II cervical cancer were enrolled between 2009 and 2013 (n = 393). INTERVENTION(S): Planned fertility-sparing trachelectomy. MAIN OUTCOME MEASURE(S): Cumulative incidences and clinicopathological characteristics of those who developed subsequent pregnancy were examined. RESULT(S): There were 77 (21.6%) women who had subsequent pregnancies after fertility-sparing trachelectomy with 1-, 2-, and 5-year cumulative pregnancy rates of 2.8%, 6.2%, and 17.4%, respectively. The median time to develop subsequent pregnancy was 3.2 years. In a competing risk analysis, women had a higher risk of recurrent cancer than conception during the first 11 months postsurgery. On multivariable analysis, younger age, being married, and postoperative reproductive treatment were independently associated with an increased chance of developing a subsequent pregnancy. The subsequent pregnancy index (SPI) score to predict the likelihood of having pregnancy was proposed, and it was calculated based on age, marital status, and reproductive treatment (2, 2, and 4 points, respectively). Women with a higher SPI score had significantly higher subsequent pregnancy rates (5-year pregnancy rate; the score was 3 in 4.7% of cases; 4 to 5 in 11.3%; 6 to 7 in 27.4%; and 8 in 50.8%), but they had similar recurrence rates (5.0%). CONCLUSION(S): The SPI score proposed in our study is useful in predicting subsequent pregnancy in women with early-stage cervical cancer undergoing fertility-sparing trachelectomy.
OBJECTIVE: To evaluate timing and a prediction model for pregnancy in early-stage cervical cancerpatients who underwent fertility-sparing trachelectomy. DESIGN: Retrospective cohort. SETTING: Academic multicenter. PATIENT(S): Women ages <45 years with clinical stage I-II cervical cancer were enrolled between 2009 and 2013 (n = 393). INTERVENTION(S): Planned fertility-sparing trachelectomy. MAIN OUTCOME MEASURE(S): Cumulative incidences and clinicopathological characteristics of those who developed subsequent pregnancy were examined. RESULT(S): There were 77 (21.6%) women who had subsequent pregnancies after fertility-sparing trachelectomy with 1-, 2-, and 5-year cumulative pregnancy rates of 2.8%, 6.2%, and 17.4%, respectively. The median time to develop subsequent pregnancy was 3.2 years. In a competing risk analysis, women had a higher risk of recurrent cancer than conception during the first 11 months postsurgery. On multivariable analysis, younger age, being married, and postoperative reproductive treatment were independently associated with an increased chance of developing a subsequent pregnancy. The subsequent pregnancy index (SPI) score to predict the likelihood of having pregnancy was proposed, and it was calculated based on age, marital status, and reproductive treatment (2, 2, and 4 points, respectively). Women with a higher SPI score had significantly higher subsequent pregnancy rates (5-year pregnancy rate; the score was 3 in 4.7% of cases; 4 to 5 in 11.3%; 6 to 7 in 27.4%; and 8 in 50.8%), but they had similar recurrence rates (5.0%). CONCLUSION(S): The SPI score proposed in our study is useful in predicting subsequent pregnancy in women with early-stage cervical cancer undergoing fertility-sparing trachelectomy.
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