Advertisement

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

  • Author Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    Jiří Sláma
    Correspondence
    Correspondence to: prof. Jiri Slama, MD, PhD, Department of Gynecology and Obstetrics, General University Hospital and 1st Faculty of Medicine, Charles University, Apolinarska 18, 128 51, Prague 2, Czech Republic Tel.: +420 224967451
    Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    Affiliations
    Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
    Search for articles by this author
  • Author Footnotes
    b Member of the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe (AGO)
    Ingo Bernard Runnebaum
    Footnotes
    b Member of the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe (AGO)
    Affiliations
    Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
    Search for articles by this author
  • Author Footnotes
    c Member of the Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO)
    Giovanni Scambia
    Footnotes
    c Member of the Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO)
    Affiliations
    Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart Rome, Rome, Italy
    Search for articles by this author
  • Author Footnotes
    d Member of the Groupe d’Investigateurs National des Etudes des Cancers Ovariens (GINECO)
    Martina Aida Angeles
    Footnotes
    d Member of the Groupe d’Investigateurs National des Etudes des Cancers Ovariens (GINECO)
    Affiliations
    Claudius Regaud Institute - University Cancer Institute, Toulouse, France
    Search for articles by this author
  • Author Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    Kiarash Bahrehmand
    Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    Affiliations
    Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary
    Search for articles by this author
  • Author Footnotes
    b Member of the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe (AGO)
    Stefan Kommoss
    Footnotes
    b Member of the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe (AGO)
    Affiliations
    Tuebingen University Hospital, Department of Women’s Health, Tuebingen, Germany
    Search for articles by this author
  • Author Footnotes
    c Member of the Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO)
    Anna Fagotti
    Footnotes
    c Member of the Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO)
    Affiliations
    Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart Rome, Rome, Italy
    Search for articles by this author
  • Author Footnotes
    d Member of the Groupe d’Investigateurs National des Etudes des Cancers Ovariens (GINECO)
    Fabrice Narducci
    Footnotes
    d Member of the Groupe d’Investigateurs National des Etudes des Cancers Ovariens (GINECO)
    Affiliations
    Department of Gynecology Oncology, Oscar Lambret Cancer Center, Lille, France
    Search for articles by this author
  • Author Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    Olga Matylevich
    Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    Affiliations
    Gynecologic Oncology Department, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus
    Search for articles by this author
  • Author Footnotes
    b Member of the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe (AGO)
    Jessica Holly
    Footnotes
    b Member of the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe (AGO)
    Affiliations
    Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
    Search for articles by this author
  • Author Footnotes
    c Member of the Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO)
    Fabio Martinelli
    Footnotes
    c Member of the Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO)
    Affiliations
    Fondazione IRCCS Istituto Nazionale Tumori - Milan, Milan, Italy
    Search for articles by this author
  • Author Footnotes
    d Member of the Groupe d’Investigateurs National des Etudes des Cancers Ovariens (GINECO)
    Meriem Koual
    Footnotes
    d Member of the Groupe d’Investigateurs National des Etudes des Cancers Ovariens (GINECO)
    Affiliations
    Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, Paris, France
    Search for articles by this author
  • Author Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    Viacheslav Kopetskyi
    Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    Affiliations
    Department of Gynecologic Oncology, National Cancer Institute, Kyiv, Ukraine
    Search for articles by this author
  • Author Footnotes
    b Member of the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe (AGO)
    Ahmed El-Balat
    Footnotes
    b Member of the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe (AGO)
    Affiliations
    University Clinic Frankfurt, Goethe-University, Department of Gynecology and Obstetrics, Frankfurt am Main, Germany; Spital Uster, Women’s Hospital, Uster, Switzerland
    Search for articles by this author
  • Author Footnotes
    c Member of the Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO)
    Giacomo Corrado
    Footnotes
    c Member of the Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO)
    Affiliations
    Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart Rome, Rome, Italy
    Search for articles by this author
  • Author Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    Mihai Emil Căpîlna
    Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    Affiliations
    First Obstetrics and Gynecology Clinic, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology Târgu Mureș, Târgu Mureș, Romania
    Search for articles by this author
  • Author Footnotes
    b Member of the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe (AGO)
    Willibald Schröder
    Footnotes
    b Member of the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe (AGO)
    Affiliations
    Gynaekologicum Bremen, Bremen, Germany
    Search for articles by this author
  • Author Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    Zoltán Novàk
    Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    Affiliations
    Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary
    Search for articles by this author
  • Author Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    Alexander Shushkevich
    Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    Affiliations
    Gynecologic Oncology Department, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus
    Search for articles by this author
  • Author Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    Lenka Fricová
    Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    Affiliations
    Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
    Search for articles by this author
  • Author Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    David Cibula
    Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    Affiliations
    Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
    Search for articles by this author
  • Author Footnotes
    a Member of the Central and Eastern European Gynecologic Oncology Group (CEEGOG)
    b Member of the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe (AGO)
    c Member of the Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO)
    d Member of the Groupe d’Investigateurs National des Etudes des Cancers Ovariens (GINECO)
Published:November 22, 2022DOI:https://doi.org/10.1016/j.ajog.2022.11.1295
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      BACKGROUND

      Fertility-sparing treatment in patients with cervical cancer should, in principle, follow identical algorithms to that in patients without future reproductive plans. In recent years, a trend towards non-radical procedures such as conization or simple trachelectomy has become apparent in medical literature, because of their associations with better pregnancy outcomes. However, the published reports included small numbers of patients and heterogenous treatment strategies to ascertain safety of such approaches.

      OBJECTIVE

      Our aims were to collect multi-institutional data regarding the oncological outcomes after fertility-sparing treatment in cervical cancer patients and to identify prognostic risk factors, including the influence of the radicality of individual cervical procedures.

      METHODS

      Patients aged 18–40 years with FIGO 2018 stage IA1 + lymphovascular space invasion or ≥IA2 cervical cancer who underwent any type of fertility-sparing procedure were eligible for this retrospective observational study, regardless of their histotype, tumor grade, and history of neoadjuvant chemotherapy. Associations between disease- and treatment-related characteristics with the risk of recurrence were analyzed.

      RESULTS

      A total of 733 patients from 44 institutions across 13 countries were included in this study. Almost half of the patients had stage IB1 cervical cancer (49%), and two-thirds were nulliparous (66%). After a median follow-up of 72 months, 51 patients (7%) experienced recurrence of whom 19 (2.6%) died due to the disease. The most common sites of recurrence were the cervix (53%) and pelvic nodes (22%). The risk of recurrence was three times higher in patients with tumors >2 cm in size than in patients with smaller tumors, irrespective of the treatment radicality (19.4% vs. 5.7%; hazard ratio 2.982, 95% CI 1.383–6.431, P = .005). The recurrence risk in patients with tumors ≤2 cm in size did not differ between patients who underwent radical trachelectomy or non-radical (conization and simple trachelectomy) cervical procedures (P = .957), regardless of tumor size subcategory (<1 or 1–2 cm) or lymphovascular space invasion.

      CONCLUSIONS

      Fertility-sparing non-radical cervical procedures were not associated with increased risk of recurrence compared with radical procedures in patients with tumors ≤2 cm in size in this large, multicenter retrospective study. The risk of recurrence after any type of fertility-sparing procedure was significantly greater in patients with tumors >2 cm in size.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect