Survival Outcomes in Patients With 2018 FIGO Stage IA2-IIA2 Cervical Cancer Treated With Laparoscopic Versus Open Radical Hysterectomy: A Propensity Score-Weighting Analysis.

Wancheng Zhao,Fangfang Bi,Yunyun Xiao,Qing Yang,Wei Zhao

doi:10.3389/fonc.2021.682849

Abstract

ObjectiveTo compare the survival and recurrence outcomes between open and laparoscopic radically hysterectomy (RH) for stage IA2-IIA2 cervical cancer based on Federation International of Gynecology and Obstetrics (FIGO) 2018.MethodsData of 1,373 early cervical cancer patients undergoing open or laparoscopic radically hysterectomy at ShengJing Hospital of China Medical University between January 1, 2013, and December 31, 2016, were retrospectively reviewed. Propensity score-based inverse probability of treatment weighting (PS-IPTW) was used to balance the covariates between the two groups.ResultsA total of 705 cervical cancer patients of FIGO 2009 stage IA2-IIA2 were finally enrolled in this study. After IPTW adjustment, the OS (HR = 2.095, 95% CI: 1.233-3.562, P = 0.006) and PFS (HR = 1.950, 95%CI: 1.194-3.184, P = 0.008) rates were significantly higher in the open RH (ORH) group compared with the laparoscopic RH (LRH) group. Then after re-staging according to the FIGO 2018 staging system, 561 patients still belonged to stage IA2-IIA2, 144 patients were upgraded to stage IIIC1p-IIIC2p. The ORH group had a significantly superior OS (HR = 1.977, 95%CI: 1.077-3.626, P = 0.028) and PFS (HR = 1.811, 95%CI: 1.046-3.134, P = 0.034) compared with the LRH group after PS-IPTW analysis. Furthermore, in patients with no high and intermediate risks, difference of the OS (HR = 1.386, 95%CI: 0.287-6.69, P = 0.684) and PFS (HR = 1.524, 95%CI: 0.363-6.396, P = 0.565) rates between the two groups were with no statistical meaning.ConclusionsOutcomes of this retrospective cohort study were in compliance with indications for ORH recommended by the National Comprehensive Cancer Network guidelines Version 1, 2021. However, LRH showed non-inferiority for patients with no prognostic risk factors compared with ORH.

Highlights

Cervical cancer was the fourth most common cancer in women worldwide
A phase III randomized, open-label, noninferiority clinical trial named the Laparoscopic Approach to Cervical Cancer identified that cervical cancer patients of Federation International of Gynecology and Obstetrics (FIGO) 2009 stage IA1 with lymphovascular invasion, IA2 and IB2 in the minimally invasive surgery (MIS) group had almost four times the risk of recurrence and 6 times the risk of death compared with the women in the open radically hysterectomy (ORH) group [7]
All the enrolled patients were re-staged according to the FIGO 2018 classification

Summary

Introduction

Cervical cancer was the fourth most common cancer in women worldwide. The estimated global yearly incidence of cervical cancer in 2018 was 570,000 cases, among which China contributing approximately one fifth [1]. Disputes about the prognostic outcomes of the cervical cancer patients underwent the open radically hysterectomy (ORH) or minimally invasive surgery (MIS) laparoscopic hysterectomy had persisted nearly 25 years since the introduction of the laparoscopic approach in 1992 [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18]. A phase III randomized, open-label, noninferiority clinical trial named the Laparoscopic Approach to Cervical Cancer identified that cervical cancer patients of Federation International of Gynecology and Obstetrics (FIGO) 2009 stage IA1 with lymphovascular invasion, IA2 and IB2 in the MIS group had almost four times the risk of recurrence and 6 times the risk of death compared with the women in the ORH group [7]. The European Society of Gynecological Oncology (ESGO), the British Gynecological Cancer Society (BGCS), and two other epidemiologic studies had the same opinion [9, 19, 20]

Methods

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Conclusion