The safety of fertility preservation for microinvasive cervical adenocarcinoma: a meta-analysis and trial sequential analysis
- 129 Downloads
This study sought to evaluate the safety of conservative treatment in the management of patients with microinvasive cervical adenocarcinoma.
The PubMed, PMC, EMBASE, Web of Science and Cochrane databases were searched to collect correlational studies published in English between January 1949 and May 2018. Series reports that evaluating the oncological prognoses of patients with microinvasive cervical adenocarcinoma who were treated with fertility-sparing surgery versus hysterectomy were pooled for meta-analysis and trial sequential analysis.
A total of 8 articles with 1256 patients were collected, including 7 retrospective reviews and 1 prospective study. Only one (0.08%) patient had parametrial involvement. Positive margins of surgical specimens were identified in 6 patients (2.2%). Lymph node metastasis was found in 5 patients (0.4%). The progression-free survival and overall survival rates were 99.3 and 98.2%. Fertility-sparing surgery had no adverse impact on recurrence or survival (P = 0.524 and 0.485, respectively). Regarding potential selection bias, significantly more patients with stage IA2 tumors than those with stage IA1 disease were treated with hysterectomy (P < 0.001). The trial sequential analysis indicated that the cumulative number of patients failed to meet the required sample size (number of patients).
The prognosis for patients with microinvasive cervical adenocarcinoma is excellent. Fertility preservation is at least appropriate for young women with stage IA1 adenocarcinoma. Further studies are still warranted to evaluate the safety of this procedure in managing patients with microinvasive cervical adenocarcinoma.
KeywordsCervical cancer Microinvasive adenocarcinoma Fertility preservation Safety
This work is supported by the Foreign Cooperation Projects of Chinese Ministry of Science and Technology (No. 2012DFA30490), and Beijing Natural Science Foundation (No. 7172077).
YF: project development, data collection and management, data analysis, manuscript writing. ZZ: data collection and management, data analysis. TL: data collection and management, data analysis. SW: data collection and management, data analysis. HB: project development, data collection and management, data analysis, manuscript writing. ZZ: project development, data collection and management, data analysis, manuscript writing.
This study was funded by the Foreign Cooperation Projects of Chinese Ministry of Science and Technology (No. 2012DFA30490), and Beijing Natural Science Foundation (No. 7172077).
Compliance with ethical standards
Conflict of interest
Author Ying Feng declares that she has no conflict of interest. Author Zihan Zhang declares that she has no conflict of interest. Author Tong Lou declares that she has no conflict of interest. Author Shuzhen Wang declares that she has no conflict of interest. Author Huimin Bai declares that she has no conflict of interest. Author Zhenyu Zhang declares that he has no conflict of interest.
This article does not contain any studies with human participants performed by any of the authors.
- 3.Horner MJ, Altekruse SF, Zou Z, Wideroff L, Katki HA, Stinchcomb DG (2011) US geographic distribution of prevaccine era cervical cancer screening, incidence, stage, and mortality. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive. Oncology 20(4):591–599. https://doi.org/10.1158/1055-9965.EPI-10-1183 CrossRefGoogle Scholar
- 5.Silverberg SG, Ioffe OB Pathology of cervical cancer. 9(5):335–347Google Scholar
- 6.UK Cancer research. http://www.cancerresearchuk.org. Accessed Nov 2010
- 8.American Cancer Society (2017) Cancer Facts & Figures 2017. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2017/cancer-facts-and-figures-2017.pdf
- 12.Centers for Disease Control and Prevention (CDC) CfDCaP (2011) Reproductive health. Infertility FAQs. <http://www.cdc.gov/reproductivehealth/Infertility/index.htm>
- 14.NCCN Clinical Practice Guidelines in oncology (NCCN Guidelines®) cervical cancer. Version 1.2017—October 10.2016 (2017). National Comprehensive Cancer NetworkGoogle Scholar
- 17.Baalbergen A, Smedts F, Helmerhorst TJ (2011) Conservative therapy in microinvasive adenocarcinoma of the uterine cervix is justified: an analysis of 59 cases and a review of the literature. Int J Gynecol Cancer 21(9):1640–1645. https://doi.org/10.1097/IGC.0b013e3182262059 CrossRefPubMedGoogle Scholar
- 26.Ceballos KM, Shaw D, Daya D (2006) Microinvasive cervical adenocarcinoma (FIGO stage 1A tumors): results of surgical staging and outcome analysis. Am J surg Pathol 30(3):370–374. https://doi.org/10.1097/01.pas.0000186398.18206.ff CrossRefPubMedGoogle Scholar
- 37.Ruengkhachorn I, Hanamornroongruang S, Leelaphatanadit C, Sangkarat S (2016) Does microinvasive adenocarcinoma of cervix have poorer treatment outcomes than microinvasive squamous cell carcinoma? Asian Pac J Cancer prevention 17(8):4013–4017Google Scholar
- 41.Brok J, Thorlund K, Wetterslev J, Gluud C (2009) Apparently conclusive meta-analyses may be inconclusive–Trial sequential analysis adjustment of random error risk due to repetitive testing of accumulating data in apparently conclusive neonatal meta-analyses. Int J Epidemiol 38(1):287–298. https://doi.org/10.1093/ije/dyn188 CrossRefPubMedGoogle Scholar
- 43.Thorlund K EJ WJ, Brok J, Imberger G, Gluud C. (2011) User manual for trial sequential analysis (TSA). copenhagen trial unit, centre for clinical intervention research, Copenhagen, Denmark p 1–115. Available from www.ctu.dk/tsa
- 53.Hartman CA, Teixeira JC, Barbosa SB, Figueiredo SM, Andrade LA, Bastos JF (2017) Analysis of conservative surgical treatment and prognosis of microinvasive squamous cell carcinoma of the cervix stage IA1: results of follow-up to 20 years. Int J Gynecol Cancer 27(2):357–363. https://doi.org/10.1097/igc.0000000000000887 CrossRefPubMedGoogle Scholar
- 54.Munro A, Leung Y, Spilsbury K, Stewart CJ, Semmens J, Codde J, Williams V, O’Leary P, Steel N, Cohen P (2015) Comparison of cold knife cone biopsy and loop electrosurgical excision procedure in the management of cervical adenocarcinoma in situ: what is the gold standard? Gynecol Oncol 137(2):258–263. https://doi.org/10.1016/j.ygyno.2015.02.024 CrossRefPubMedGoogle Scholar
- 56.Latif NA, Neubauer NL, Helenowski IB, Lurain JR (2015) Management of adenocarcinoma in situ of the uterine cervix: a comparison of loop electrosurgical excision procedure and cold knife conization. J Low Genit tract Dis 19(2):97–102. https://doi.org/10.1097/LGT.0000000000000055 CrossRefPubMedGoogle Scholar
- 58.Twu NF, Ou YC, Liao CI, Chang WY, Yang LY, Tang YH, Chen TC, Chen CH, Chen TH, Yeh LS, Hsu ST, Chen YC, Chang CC, Cheng YM, Huang CY, Liu FS, Lin YS, Hsiao SM, Kan YY, Lai CH (2016) Prognostic factors and adjuvant therapy on survival in early-stage cervical adenocarcinoma/adenosquamous carcinoma after primary radical surgery: a Taiwanese Gynecologic Oncology Group (TGOG) study. Surg Oncol 25(3):229–235. https://doi.org/10.1016/j.suronc.2016.05.028 CrossRefPubMedGoogle Scholar
- 60.Zhang W, Zhang J, Yang J, Xue H, Cao D, Huang H, Wu M, Cui Q, Chen J, Lang J, Shen K (2014) The role of magnetic resonance imaging in pretreatment evaluation of early-stage cervical cancer. Int J Gynecol Cancer 24(7):1292–1298. https://doi.org/10.1097/igc.0000000000000169 CrossRefPubMedGoogle Scholar