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Protective Role of Conization Before Radical Hysterectomy in Early-Stage Cervical Cancer: A Propensity-Score Matching Study

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to assess the prognostic role and the perioperative outcomes of conization performed before radical hysterectomy in early-stage cervical carcinoma.

Methods

This multicenter, retrospective observational cohort study included patients with FIGO 2009 stage IB1 cervical carcinoma treated with radical hysterectomy between June 2004 and June 2019. Patients were divided into two groups according to conization before radical surgery. One-to-one case–control matching was used to adjust the baseline characteristics.

Results

A total of 332 patients were included after propensity matching (166, 50% in each group). Twenty-four of 166 (14.4%) and 142 of 166 (85.6%) conization patients had negative and positive surgical margins on the conization specimen, respectively. No difference in intra- and postoperative complications was noted between the two groups (p = 0.542 and p = 0.180, respectively). Patients undergoing conization before radical hysterectomy received less adjuvant treatment (p < 0.001) and had a better 5-year disease-free survival (DFS) than patients who did not receive conization (89.8% vs. 80.0%, respectively; p = 0.010). No difference in 5-year overall survival (OS) (97.1% vs. 91.4%, respectively; p = 0.114) or recurrence pattern (p = 0.115) was reported between the two groups. Factors independently related to higher risk of recurrence were pathologic tumor diameter >20 mm and no conization before radical hysterectomy (p = 0.011 and p = 0.018, respectively). The only independent variable influencing OS was pathologic tumor diameter >20 mm (p = 0.020).

Conclusions

Conization before radical hysterectomy was associated with improved DFS and lower probability of receiving adjuvant treatment. No difference in perioperative complications and OS was evident. Tumor diameter >20 mm was found to be the only independent risk factor affecting OS in both groups.

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REFERENCES

  1. Brisson M, Kim JJ, Canfell K, et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020;395(10224):575–90.

    Article  Google Scholar 

  2. Wright TC, Stoler MH, Behrens CM, et al. Primary cervical cancer screening with human papillomavirus: end of study results from the ATHENA study using HPV as the first-line screening test. Gynecol Oncol. 2015;136(2):189–97.

    Article  Google Scholar 

  3. Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):e191-203.

    Article  Google Scholar 

  4. Cibula D, Pötter R, Planchamp F, et al. The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the Management of Patients With Cervical Cancer. Int J Gynecol Cancer. 2018;28(4):641–55.

    Article  Google Scholar 

  5. Uppal S, Gehrig PA, Peng K, et al. Recurrence rates in patients with cervical cancer treated with abdominal versus minimally invasive radical hysterectomy: a multi-institutional retrospective review study. J Clin Oncol. 2020;38(10):1030–40.

    Article  Google Scholar 

  6. Casarin J, Bogani G, Papadia A, et al. Preoperative conization and risk of recurrence in patients undergoing laparoscopic radical hysterectomy for early stage cervical cancer: a multicenter study. J Minim Invasive Gynecol. 2020;28:117–23.

    Article  Google Scholar 

  7. Pecorelli S, Zigliani L, Odicino F. Revised FIGO staging for carcinoma of the cervix. Int J Gynaecol Obstet. 2009;105(2):107–8.

    Article  Google Scholar 

  8. Querleu D, Cibula D, Abu-Rustum NR. 2017 Update on the Querleu-Morrow Classification of radical hysterectomy. Ann Surg Oncol. 2017;24(11):3406–12.

    Article  Google Scholar 

  9. Common Terminology Criteria for Adverse Events (CTCAE) v5.0. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_5x7.pdf.

  10. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  Google Scholar 

  11. Kaplan EL, Meier P. Nonparametric estimation from incomplete observation. J Am Stat Assoc. 1958;53:457–81.

    Article  Google Scholar 

  12. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966;50(3):163–70.

    CAS  PubMed  Google Scholar 

  13. Cox DR. Models and Life-Tables Regression. J R Stat Soc Ser B (Methodological). 1972;34(2):187–220.

    Google Scholar 

  14. Duggan BD, Felix JC, Muderspach LI, et al. Cold-knife conization versus conization by the loop electrosurgical excision procedure: a randomized, prospective study. Am J Obstet Gynecol. 1999;180(2 Pt 1):276–82.

    Article  CAS  Google Scholar 

  15. Jiang YM, Chen CX, Li L. Meta-analysis of cold-knife conization versus loop electrosurgical excision procedure for cervical intraepithelial neoplasia. Oncol Targets Ther. 2016;9:3907–15.

    Article  Google Scholar 

  16. Derks M, van der Velden J, de Kroon CD, et al. Surgical treatment of early-stage cervical cancer: a multi-institution experience in 2124 cases in The Netherlands over a 30-year period. Int J Gynecol Cancer. 2018;28(4):757–63.

    Article  Google Scholar 

  17. Matsuo K, Mandelbaum RS, Machida H, et al. Association of tumor differentiation grade and survival of women with squamous cell carcinoma of the uterine cervix. J Gynecol Oncol. 2018;29(6):e91.

    Article  Google Scholar 

  18. Allam M, Feely C, Millan D, Nevin J, Davis J, Siddiqui N. Depth of cervical stromal invasion as a prognostic factor after radical surgery for early stage cervical cancer. Gynecol Oncol. 2004;93(3):637–41.

    Article  Google Scholar 

  19. Ramirez PT, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med. 2018;379(20):1895–904.

    Article  Google Scholar 

  20. Pedone Anchora L, Turco LC, Bizzarri N, et al. How to select early-stage cervical cancer patients still suitable for laparoscopic radical hysterectomy: a propensity-matched study. Ann Surg Oncol. 2020;27(6):1947–55.

    Article  Google Scholar 

  21. Chiva L, Zanagnolo V, Querleu D, et al. SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer. Int J Gynecol Cancer. 2020;30(9):1269–77.

    Article  Google Scholar 

  22. Kong TW, Chang SJ, Piao X, et al. Patterns of recurrence and survival after abdominal versus laparoscopic/robotic radical hysterectomy in patients with early cervical cancer. J Obstet Gynaecol Res. 2016;42(1):77–86.

    Article  Google Scholar 

  23. Kanao H, Matsuo K, Aoki Y, et al. Feasibility and outcome of total laparoscopic radical hysterectomy with no-look no-touch technique for FIGO IB1 cervical cancer. J Gynecol Oncol. 2019;30(3):e71.

    Article  Google Scholar 

  24. Kohler C, Hertel H, Herrmann J, et al. Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff: a multicenter analysis. Int J Gynecol Cancer. 2019;29(5):845–50.

    Article  Google Scholar 

  25. Pedone Anchora L, Bizzarri N, Kucukmetin A, et al. Investigating the possible impact of peritoneal tumor exposure amongst women with early stage cervical cancer treated with minimally invasive approach [published online ahead of print, 2020 Oct 3]. Eur J Surg Oncol. 2020;S0748-7983(20)30829-5.

  26. Orr JW Jr, Shingleton HM, Hatch KD, Mann WJ Jr, Austin JM Jr, Soong SJ. Correlation of perioperative morbidity and conization to radical hysterectomy interval. Obstet Gynecol. 1982;59(6):726–31.

    PubMed  Google Scholar 

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Acknowledgment

The authors thank the surgical team and the scrub nurses at Policlinico Gemelli IRCCS, Rome, Italy and at Northern Gynaecological Oncology Centre, Gateshead, UK.

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Authors and Affiliations

  1. Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, IRCCS, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy

    Nicolò Bizzarri MD, Luigi Pedone Anchora MD, Vittoria Carbone MD, Camilla Fedele MD, Matteo Bruno MD, Giuseppe Vizzielli MD, Valerio Gallotta MD, Rosa De Vincenzo MD, Anna Fagotti MD, Francesco Fanfani MD, Gabriella Ferrandina PhD & Giovanni Scambia MD

  2. Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK

    Ali Kucukmetin MD, Nithya Ratnavelu MD & Porfyrios Korompelis PhD

  3. Università Cattolica del Sacro Cuore, Rome, Italy

    Rosa De Vincenzo MD, Anna Fagotti MD, Francesco Fanfani MD, Gabriella Ferrandina PhD & Giovanni Scambia MD

  4. Department of Gynecologic Oncology, ARNAS Ospedali Civico Di Cristina Benfratelli, University of Palermo, Palermo, Italy

    Vito Chiantera MD

Authors
  1. Nicolò Bizzarri MD
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  2. Luigi Pedone Anchora MD
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  3. Ali Kucukmetin MD
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  4. Nithya Ratnavelu MD
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  5. Porfyrios Korompelis PhD
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  6. Vittoria Carbone MD
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  7. Camilla Fedele MD
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  8. Matteo Bruno MD
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  9. Giuseppe Vizzielli MD
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  10. Valerio Gallotta MD
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  11. Rosa De Vincenzo MD
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  12. Vito Chiantera MD
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  13. Anna Fagotti MD
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  14. Francesco Fanfani MD
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  15. Gabriella Ferrandina PhD
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  16. Giovanni Scambia MD
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Contributions

Conceptualization: NB, LPA, GS; Data curation: NB, LPA, PK, VC, MVC, MB; Formal analysis: NB, LPA; Methodology: AKM, NR, VC, GV, VC, AF, FF, GF; Project administration: NB, GS; Supervision: GS; Validation: GF, FF, AKM, NR, RPDV; Writing - original draft: NB, GS; Writing - review & editing: AKM, NR, GF, FF, LPA.

Corresponding author

Correspondence to Luigi Pedone Anchora MD.

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Disclosures

Anna Fagotti's disclosures of interest: Grant/Research Support: MSD Italia S.r.l.; Consultant for: Glaxo Smith Kline p.l.c.; Speakers Bureau/Honoraria: PharmaMar S.A.; Consultant for: Johnson & Johnson SpA; The other authors declare no conflict of interest.

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Bizzarri, N., Pedone Anchora, L., Kucukmetin, A. et al. Protective Role of Conization Before Radical Hysterectomy in Early-Stage Cervical Cancer: A Propensity-Score Matching Study. Ann Surg Oncol 28, 3585–3594 (2021). https://doi.org/10.1245/s10434-021-09695-4

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  • DOI: https://doi.org/10.1245/s10434-021-09695-4

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