Long-term oncological outcomes and recurrence patterns in early-stage cervical cancer treated with minimally invasive versus abdominal radical hysterectomy: The Norwegian Radium Hospital experience

Bilal M Sert,Gunnar B Kristensen,Andreas Kleppe,Anne Dørum

doi:10.1016/j.ygyno.2021.05.028

Bilal M Sert, Gunnar B Kristensen + Show 2 more

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https://doi.org/10.1016/j.ygyno.2021.05.028

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Abstract

ObjectiveTo compare long-term oncological outcomes in early-stage cervical cancer (CC) patients treated with minimally invasive radical hysterectomy (MIRH) versus abdominal radical hysterectomy (ARH), with a focus on recurrence patterns, tumor sizes, and conization. MethodsThis single-institution, retrospective study consisted of stage IA1-IB1 (FIGO 2009) squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma of the cervix, who underwent radical hysterectomy between 2000 and 2017. ResultsOf the 582 patients included, 353 (60.7%) underwent ARH, and 229 (39.3%) MIRH. The median follow-up was 14.4 years in the ARH group and 6.1 years in the MIRH group (p < 0.0001). Among the 96 stage IA patients, only 3 (3.1%) experienced recurrence. Among stage IB1 patients, the risk of recurrence, after adjusting for standard prognostic variables, was twofold higher in the MIRH group versus the ARH group (HR 2.73, 95% CI: 1.56–4.80), and the relative difference was similar in terms of risk of cancer-specific survival (CSS) (HR 3.04, 95% CI: 1.28–7.20) and overall survival (OS) (HR 2.35, 95% CI: 1.21–4.59). In stage IB1 ≤ 2 cm patients without conization MIRH was associated with reduced time to recurrence (TTR) (HR 4.00, 95% CI: 1.67–9.57), CSS (HR 3.71, 95% CI: 1.19–11.58) and OS (HR 3.02, 95% CI: 1.24–7.34). Intraperitoneal combined recurrences accounted for 12 of 30 (40.0%) recurrences in the MIRH group but were not identified after ARH (p = 0.0001). ConclusionsMIRH was associated with reduced TTR, CSS and OS versus ARH in stage IB1 CC patients. The risk of peritoneal recurrence was high, even for tumors ≤2 cm without conization.

Highlights

Cervical cancer (CC) is the fourth most common cancer among women worldwide [1], with approximately 570,000 new cases and 311,000 deaths in 2018
Among stage IB1 patients, the risk of recurrence, after adjusting for standard prognostic variables, was twofold higher in the minimally invasive radical hysterectomy (MIRH) group versus the ARH group (HR 2.73, 95% CI: 1.56–4.80), and the relative difference was similar in terms of risk of cancer-specific survival (CSS) (HR 3.04, 95% CI: 1.28–7.20) and overall survival (OS) (HR 2.35, 95% CI: 1.21–4.59)
In stage IB1 ≤ 2 cm patients without conization MIRH was associated with reduced time to recurrence (TTR) (HR 4.00, 95% CI: 1.67–9.57), CSS (HR 3.71, 95% CI: 1.19–11.58) and OS (HR 3.02, 95% CI: 1.24–7.34)

Summary

Introduction

Cervical cancer (CC) is the fourth most common cancer among women worldwide [1], with approximately 570,000 new cases and 311,000 deaths in 2018. Associated with reduced operative morbidity, shorter hospital length of stay and similar oncological outcomes compared to ARH in patients with early-stage CC [6,7,8]. The results from the first prospective, randomized clinical trial of stage IA1-IB1 CC were published in 2018. This multicenter, phase III trial [Laparoscopic Approach to Cervical Cancer (LACC)] with CC stage IA1-IB1, recruited patients from 2008 to 2017 and had disease-free survival (DFS) at 4.5 years as the primary endpoint. An epidemiologic study demonstrated that MIRH was significantly associated with shorter OS than ARH among CC patients with stage IA2-IB1 malignancy [16]

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