BACKGROUND AND PURPOSE:

• Nonradical procedures have become more common for patients with cervical cancer who want to become pregnant
• Slama et al. (AJOG, 2023) analyzed oncological outcomes after fertility-sparing treatment in patients with cervical cancer including prognostic risk factors

METHODS:

• Retrospective observational study
• Population
  • 18 to 40 years
  • Stage IA1 with positive lymphovascular space invasion or ≥IA2 cervical cancer
  • Underwent any type of fertility-sparing procedure
• Exposures
  • Disease-related characteristics
  • Treatment-related characteristics
• Study design
  • Inclusion criteria
    • Conization (any technique) | Simple vaginal trachelectomy | Vaginal or abdominal radical trachelectomy
    • Any surgical approach (laparotomy vs minimally invasive)
  • Exclusion
    • Hysterectomy as part of primary treatment
• Primary outcome
  • Risk of recurrence

RESULTS:

• 733 patients across 13 countries
  • Mean age: 32.2 years
  • Stage IB1 cervical cancer: 49%
  • Nulliparous: 66%
  • Median follow-up: 72 months
• Recurrence: 7%
  • Cervical cancer related deaths: 2.6%
• The most common sites of recurrence
  • Cervix: 53% | Pelvic nodes: 22%
• The risk of recurrence was 3 times higher in patients with tumors >2 cm in size than in patients with smaller tumors, irrespective of the
  • Tumors >2 cm: 19.4% | Smaller tumors: 5.7%
  • Hazard ratio (HR) 2.982 (95% CI, 1.383 to 6.431) | P=0.005
  • Results did not differ based on treatment radicality
• The recurrence risk in patients with tumors ≤2 cm in size (P=0.957)
  • Did not differ between patients who underwent radical trachelectomy and patients who underwent nonradical procedures such as conization and simple trachelectomy
  • Results did not differ based on tumor size subcategory or lymphovascular space invasion

CONCLUSION:

• For patients with tumors ≤2 cm, nonradical fertility-sparing cervical cancer procedures did not increase the risk of cancer recurrence vs radical procedures
• Patients with tumors >2 cm had significantly higher risk of recurrence with nonradical procedures
• The authors state

Nonradical fertility-sparing procedures represent a safe treatment option for patients with cervical cancer with HPV-associated tumors of ≤2 cm in size and negative regional LNs 

Learn More – Primary Sources:

Analysis of risk factors for recurrence in cervical cancer patients after fertility-sparing treatment: The FERTIlity Sparing Surgery retrospective multicenter study