IB Cervical Carcinoma Research Articles

The long-term outcomes of clinical responders to neoadjuvant chemotherapy followed by radical surgery in locally advanced cervical cancer.

To compare the long-term oncological outcome of neoadjuvant chemotherapy before radical surgery (NCRS) and definitive chemoradiotherapy (DR) for stage IB2 and IIA2 cervical squamous cell carcinoma. The clinical outcome of 480 patients with stage IB2 and IIA2 cervical cancer (308 clinical responders, 111 clinical non-responders, 61 unclear) who underwent NCRS (and subgroup assessments) were compared with those of 233 patients who underwent DR. The clinical response rate was 73.5% in the NCRS group. Multivariate COX regression analyses revealed that NCRS was not correlated with the 5-year overall survival (OS) rate (p = 0.067) or disease-free survival (DFS) rate (p = 0.249). In a subgroup of NCRS, the clinical response group was also shown to be a protective independent factor of 5year OS rate compared to the DR group (aHR, 0.403; 95% CI, 0.209-0.777), but had no correlation with the 5year DFS rate (p = 0.089). On the other hand, the clinical non-response group had no correlation with the 5year OS rate (p = 0.780) or DFS rate (p = 0.669). Clinical responders who underwent NCRS exhibited a better oncological outcome compared to those who underwent DR. International Clinical Trials Registry Platform Search Port, http://apps.who.int/trialsearch/ ; CHiCTR1800017778.

The MEMORY Study: MulticentEr study of Minimally invasive surgery versus Open Radical hYsterectomy in the management of early-stage cervical cancer: Survival outcomes

ObjectiveThe Laparoscopic Approach to Cervical Cancer (LACC) trial found that minimally invasive radical hysterectomy compared to open radical hysterectomy compromised oncologic outcomes and was associated with worse progression-free survival (PFS) and overall survival (OS) in early-stage cervical carcinoma. We sought to assess oncologic outcomes at multiple centers between minimally invasive (MIS) radical hysterectomy and OPEN radical hysterectomy. MethodsThis is a multi-institutional, retrospective cohort study of patients with 2009 FIGO stage IA1 (with lymphovascular space invasion) to IB1 cervical carcinoma from 1/2007–12/2016. Patients who underwent preoperative therapy were excluded. Squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinomas were included. Appropriate statistical tests were used. ResultsWe identified 1093 cases for analysis—715 MIS (558 robotic [78%]) and 378. OPEN procedures. The OPEN cohort had more patients with tumors >2 cm, residual disease in the hysterectomy specimen, and more likely to have had adjuvant therapy. Median follow-up for the MIS and OPEN cohorts were 38.5 months (range, 0.03–149.51) and 54.98 months (range, 0.03–145.20), respectively. Three-year PFS rates were 87.9% (95% CI: 84.9–90.4%) and 89% (95% CI: 84.9–92%), respectively (P = 0.6). On multivariate analysis, the adjusted HR for recurrence/death was 0.70 (95% CI: 0.47–1.03; P = 0.07). Three-year OS rates were 95.8% (95% CI: 93.6–97.2%) and 96.6% (95% CI: 93.8–98.2%), respectively (P = 0.8). On multivariate analysis, the adjusted HR for death was 0.81 (95% CI: 0.43–1.52; P = 0.5). ConclusionThis multi-institutional analysis showed that an MIS compared to OPEN radical hysterectomy for cervical cancer did not appear to compromise oncologic outcomes, with similar PFS and OS.

Outcomes and prognosis of radical surgery in patients with stageⅠb2 and Ⅱa2 cervical squamous cell carcinoma

Objective: To evaluate the survival, complications and prognostic factors in patients with stageⅠb2 and Ⅱa2 cervical squamous cell carcinoma treated by primarily radical surgery with or without postoperative adjuvant therapy. Methods: The clinical and pathological data of patients with stageⅠb2 and Ⅱa2 cervical squamous cell carcinoma treated in the Cancer Hospital of the University of Chinese Academy of Sciences from January 2015 to January 2018 were retrospectively analyzed. All patients underwent Querleu-Morrow classification (Q-M classification) C2 radical surgery, including extensive hysterectomy+pelvic lymphadenectomy with or without adjuvant therapy based on postoperative risk factors. Survival rate was calculated by Kaplan-Meier method and survival curve was drawn. Univariate analysis was performed by using the log-rank test to analyze the clinicopathological factors related to the prognosis of patients. Multivariate analysis was performed by using Cox regression method to analyze independent risk factors affecting survival prognosis. Results: (1) The median age of 643 patients with cervical squamous cell carcinoma was 50 years old (45-58 years old). Clinical stage: 260 cases (40.4%, 260/643) of stage Ⅰb2, 383 cases (59.6%, 383/643) of stage Ⅱa2. (2) Among 643 cases underwent Q-M classification C2 surgery, 574 cases (89.3%, 574/643) of them received adjuvant therapy and 184 cases (28.6%, 184/643) of them had grade 3-4 complications after treatment, including 134 cases (20.8%, 134/643) early complications and 66 cases (10.3%, 66/643) late complications. The incidence of grade 3-4 complications in 574 patients received postoperative adjuvant therapy was 30.1% (173/574), which was significantly different from that in 69 patients who received surgery alone (15.9%, 11/69; χ²=6.08, P=0.014). (3) All 643 cases were followed up, and the median follow-up time was 40 months (3-76 months). During the follow-up period, 117 cases (18.2%, 117/643) recurred, including 45 cases (7.0%, 45/643) of local recurrence, 54 cases (8.4%, 54/643) of distant metastasis, and 18 cases (2.8%, 18/643) of local recurrence and distant metastasis. The 5-year progression-free survival (PFS) and 5-year overall survival (OS) rates of patients with stage Ⅰb2 and Ⅱa2 cervical squamous cell carcinoma were 79.9% and 85.5%, respectively. Univariate analysis showed that pelvic lymph node metastasis, para-aortic lymph node metastasis, deep stromal infiltration, and lymph-vascular space invasion were significantly associated with 5-year PFS in patients with stage Ⅰb2 and Ⅱa2 cervical squamous cell carcinoma (all P<0.05). The maximum diameter of tumor, pelvic lymph node metastasis and para-aortic lymph node metastasis were significantly associated with the 5-year OS of cervical squamous cell carcinoma in stages Ⅰb2 and Ⅱa2 (all P<0.05). Multivariate analysis showed that pelvic lymph node metastasis and para-aortic lymph node metastasis were independent factors affecting 5-year PFS and 5-year OS in patients with stage Ⅰb2 and Ⅱa2 cervical squamous cell carcinoma (all P<0.01). Conclusion: Radical surgery is a feasible and effective primary treatment for stagesⅠb2 and Ⅱa2 cervical squamous cell carcinoma, with a high 5-year survival rate and an acceptable complication rate.

SUCCOR cone study: conization before radical hysterectomy

ObjectiveTo evaluate disease-free survival of cervical conization prior to radical hysterectomy in patients with stage IB1 cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009).MethodsA multicenter retrospective observational cohort...

Radical Vaginal Trachelectomy.

Recently, radical vaginal hysterectomy (RVH) has developed into laparoscopically assisted radical vaginal hysterectomy (LARVH), which is associated with the laparoscopical procedure, and it is applied as radical vaginal trachelectomy and semi-radical vaginal hysterectomy. LARVH is indicated for patients with stage IB1 and IIA1 cervical carcinoma, especially those with a tumor size of less than 2 cm, because the cardinal ligaments cannot be resected widely. Although RVH that is associated with laparoscopic pelvic lymphadenectomy is the most used surgical procedure, radical trachelectomy may be performed either abdominally or vaginally (laparoscopic or robotic). One report found that the pregnancy rate was higher in patients who underwent minimally invasive or radical vaginal trachelectomy than in those who underwent radical abdominal trachelectomy.

ConCerv: a prospective trial of conservative surgery for low-risk early-stage cervical cancer

ObjectiveThe objective of the ConCerv Trial was to prospectively evaluate the feasibility of conservative surgery in women with early-stage, low-risk cervical cancer.MethodsFrom April 2010 to March 2019, a prospective, single-arm,...

Radical hysterectomy practice patterns for early-stage cervical cancer: a cross-sectional survey of gynecologic oncologists

Objectives: In this study, we evaluated current practice patterns related to radical hysterectomies for early stage cervical cancer and how they have changed since new literature was released in 2018. Methods: This study was a cross-sectional survey of current gynecologic oncologists. The primary outcome assessed was performance of primarily open radical hysterectomies for FIGO Stages IA1, IA2, IB1, and IB2 cervical carcinoma. A secondary outcome assessed was a change in surgical practice. Multivariable logistic regression analyses were completed to assess for associations of demographic and surgical experience predictors. Additional descriptive analyses were performed to evaluate reasons physicians would consider a minimally invasive radical hysterectomy, specific changes made to surgical technique, concerns regarding the 2018 NEJM trials, and beliefs about the role of future clinical trials. Results: Of 1309 SGO members invited to participate, 249 responded (19.0%) and 218 (87.6%) complete responses were analyzed. Performance of primarily open radical hysterectomies was reported in 61.6%, 80.2%, and 88.9% of Stage IA2, IB1, and IB2 cancers, respectively. For Stage IA2 cancer, the age group of 40-49 was associated with 73% lower odds of performing primarily open hysterectomies compared to the reference group of ages 30-39 (OR 0.27, p=0.01). Female gender was associated with greater odds of performing primarily open radical hysterectomies (OR 2.03, p=0.04 for IA2, OR 3.25, p=0.01 for IB1). For Stage IB2 cancers, no demographic or surgical experience factors were statistically associated with performance of open surgery. Change from minimally invasive to open surgery was reported in 52.3%, 68.4%, and 71.1% of Stage IA2, IB1, and IB2 cancers, respectively. Change in minimally invasive technique was reported in 5.5%, 6.42%, and 5.96% of Stage IA2, IB1, and IB2 cancers, respectively. For Stage IA2 cancer, each decrease of 1 year in practice (i.e. since fellowship graduation) was associated with 10% greater odds of changing surgical route or technique. Time since fellowship graduation was associated with 23% greater odds of a change for Stage IB2 cancers. For Stage IB1 cancer, each increase in case volume by 1 radical hysterectomy annually was associated with 6% lower odds of changing surgical route or technique. Most (66.7%) physicians reported they would consider a minimally invasive hysterectomy for one or more reasons. The majority of respondents (84.7%) reported believing there is a role for additional studies evaluating the topic of route of surgery for early stage cervical cancer. Download : Download high-res image (239KB) Download : Download full-size image Conclusions: Despite emerging research demonstrating worse oncologic outcomes for minimally invasive radical hysterectomies in early stage cervical cancer, our research shows that current practices remain heterogeneous. In this study, female surgeons had greater odds of performing open surgery compared to their male colleagues for Stage IA2 and IB1 cancers. The odds for performing open surgery were lower in middle age surgeons compared to younger physicians. More recent fellowship graduation was associated with greater odds of change, indicating that more senior surgeons reported being less likely to change practice. Many individuals reported feeling there is room for additional randomized clinical trials to inform evidence-based practices. Given the high rates of practice change reported, there will also be a role for future epidemiologic studies to evaluate oncologic outcomes in the current practice environment.

Observational BGOG Study of the Results of Robot-assisted Laparoscopy in 166 Patients with FIGO 2009 Stage IA1-IB1 Cervical Cancer

Two recent studies (the Laparoscopic Approach to Cervical Cancer [LACC] trial and a cohort study based on the National Cancer Database) raise the question of whether minimally invasive surgery (conventional and robot-assisted laparoscopy) is inferior to open abdominal surgery in early-stage cervical cancer. In the laparotomy group of the LACC trial, the low rates of recurrence and death are notable. The present study wants to elucidate the current situation of patients with early-stage cervical cancer treated with robot-assisted laparoscopy in hospitals of the Belgium and Luxembourg Gynaecological Oncology Group (BGOG). This is a prospective follow-up study. The combined data obtained from different BGOG hospitals were analyzed regarding patients similar to those included in the LACC trial in terms of cervical cancer recurrence and survival. We included patients with stage IA1, IA2, or IB1 cervical cancer with a histologic subtype of squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma. All patients were treated with robot-assisted laparoscopy. The outcomes were disease-free and overall survival at 3 and 5 years after surgery. A total of 270 patients were included, and 166 were found suitable for analysis. The median age was 45 years. Most patients had International Federation of Gynecology and Obstetrics stage IB1 cervical cancer (84.9%) and squamous cell carcinoma as the histologic subtype (71.7%).The median follow-up time was 44 months, with a range of between 1 and 131 months. Twenty-one recurrences and 12 deaths were noted. Of the deaths, 8 were related to cervical cancer. Disease-free survival was 86% at 3 years (95% confidence interval [CI], 78.52-90.80) and 85% at 5 years (95% CI, 77.03-89.95). Overall survival was 96% at 3 years (95% CI, 90.11-98.22) and 91% at 5 years (95% CI, 82.54 95.17). The results of this BGOG study show disease-free and overall survival rates after robot-assisted laparoscopy in early-stage cervical cancer that are at least similar to previous reported recurrence and survival data. We expect that the results of the Robot-assisted Approach to Cervical Cancer trial will elucidate the place of robot-assisted laparoscopy in early-stage cervical cancer.

A Comparative Analysis of Robotic Single-Site Surgery and Laparoendoscopic Single-Site Surgery as Therapeutic Options for Stage IB1 Cervical Squamous Carcinoma

PurposeTo compare perioperative outcomes between robotic single-site surgical technique and conventional laparoendoscopic single-site surgical technique.MethodsThis was a retrospective cohort study involving 67 patients who received robotic single-site surgery or laparoendoscopic single-site surgery for the treatment of stage IB1 cervical squamous carcinoma. The robotic single-site radical hysterectomy technique combined with pelvic lymph node dissections were performed in 32 patients while the laparoendoscopic single-site radical hysterectomy technique combined with pelvic lymph node dissections were performed in 35 patients.ResultsThe enrolled patients had been diagnosed with stage IB1 cervical squamous carcinoma. The perioperative outcomes were mean age (51.63±8.32 years in the lymph node dissection (RSS group) and 53.14±8.14 years in the lymph node dissection (LESS group), p=0.453); BMIs (23.76±2.72 in the RSS group and 23.46±2.28 in the LESS group, p=0.629); shorter operative times (223.56±15.43 min in the RSS group and 248.61±20.89 min in the LESS group, p<0.01) and less estimated blood loss (217.25±16.77 mL in the RSS group and 294.74±24.00 mL in the LESS group, p<0.01). None of the study participants exhibited postoperative pain. There were no statistically significant differences in the length of hospital stay (p=0.865), perioperative complications (p=0.602), duration of closure and removal of catheter (p=0.518) as well as in pathological diagnoses between the two groups.ConclusionRobotic single-site surgery can be used in the treatment of early stage cervical cancer as it exhibits acceptable operative times and perioperative outcomes. This surgical technique is feasible and safe.

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

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. This multicenter, retrospective observational cohort study included patients with FIGO 2009stage 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. 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). 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.

Transumbilical Laparoendoscopic Single-Site Radical Hysterectomy without Uterine Manipulator and with Vaginal Closure

Study Objective Minimally invasive surgery (MIS) of radical hysterectomy (RH) was reported with inferior oncologic outcomes according to the New England Journal of Medicine (NEJM). Then some studies suggested that the no-touch technique may be a useful procedure to prevent tumor spillage as well as improve survival, and the procedures were improved continuously. Therefore, we performed RH targeting early-stage cervical cancer through laparoendoscopic single-site (LESS) approach with enclosed colpotomy and without uterine manipulator. Design A presentation of the surgery through this technical video. Setting A Hospital. Patients or Participants A 48-year-old postmenopausal woman was diagnosed as cervical cancer with stage IB1(FIGO 2018). Interventions After fully informed of the benefits and risks of different surgical approaches (open laparotomy and MIS), she agreed with the MIS. Measurements and Main Results The type C radical hysterectomy via LESS approach was performed successfully, the final pathologic findings confirmed stage IB1 cervical carcinoma. The patient recovered fast and well with slight pain, and the incision scar was hidden perfectly for cosmetic purpose. Conclusion This video demonstrated that LESS-RH with vaginal closure and without manipulator was feasible and safe. Suspension skills played a significant role in the LESS-RH. Besides, this surgery procedure also involved 4 specific techniques to prevent tumor spillage, including creation of a vaginal cuff, avoidance of interoperate uterine manipulator, standard extent and bagging of the specimen. These adaptations were meant to minimize tumor manipulation and disruption, for reducing the increased risk of recurrence. However, further verifications were still required.

Sentinel lymph node biopsy versus pelvic lymphadenectomy in early-stage cervical cancer: a multi-center randomized trial (PHENIX/CSEM 010)

BackgroundThere is no accepted strategy for applying sentinel lymph node (SLN) biopsy as an alternative to pelvic lymphadenectomy in cervical cancer. It is unclear whether and when pelvic lymphadenectomy can...

Impact of neoadjuvant chemotherapy on the postoperative pathology of locally advanced cervical squamous cell carcinomas: 1:1 propensity score matching analysis

ObjectiveTo assess the impact of neoadjuvant chemotherapy on postoperative pathology for stage IB2 and IIA2 cervical squamous cell carcinoma. MethodsPostoperative pathology was compared between patients who received neoadjuvant chemotherapy followed by radical hysterectomy (NACT group) and patients who received upfront radical hysterectomy (URH group). Then, patients in the NACT group were divided into a chemotherapy-sensitive group and a chemotherapy-insensitive group according to their response to chemotherapy. ResultsAfter 1:1 propensity score matching (PSM), the positive rates of lymphovascular space invasion (LVSI) (7.9% vs 17.7%, P = 0.001) and cervical deep stromal invasion (60.4% vs 76.2%, P < 0.001) in the NACT group were significantly lower than those in the URH group, while the positive rates of parametrial invasion, lymph node metastasis, and vaginal margin invasion were not significantly different between the two groups. The rate of positive lymph node metastasis in the chemotherapy-sensitive group was significantly lower than that in the URH group (18.1% vs 26.5%, P = 0.037). ConclusionAmong patients with stage IB2 and IIA2 cervical squamous cell carcinomas, NACT can reduce the positive rate of intermediate-risk factors, such as deep cervical stromal invasion and LVSI, but cannot reduce the positive rate of high-risk factors. For patients who are chemotherapy sensitive, NACT can reduce the positive rate of lymph node metastasis.

Back to the Future: Schauta-Amreich Radical Vaginal Hysterectomy Assisted by Laparoscopy with Sentinel Lymph Node Biopsy for Early-stage Cervical Cancer

The popularity of laparoscopy to perform radical hysterectomy has massively increased over the last 2 decades. However, oncologic outcomes (overall and disease-free survival) have been found to be better in patients managed by laparotomy compared with laparoscopy, challenging this surgical route. Compared with laparotomy, vaginal access reduces postoperative morbidity, while avoiding potential cancer spread associated with laparoscopy. We describe the procedure of Schauta-Amreich radical vaginal hysterectomy with bilateral salpingo-oophorectomy, assisted laparoscopically, and associated with pelvic sentinel lymph node procedure in a 56-year-old woman with an International Federation of Gynecology and Obstetrics stage IB2 cervical epidermoid carcinoma. A sentinel lymph node procedure was first performed by laparoscopy. Radical hysterectomy was prepared through laparoscopy by dividing the infundibulopelvic, round, and broad ligaments. The procedure was continued by the vaginal route using the Schuchardt incision. We describe each step of the procedure and provide a video. Histology showed a margin-free resection in both the vagina and parametrium with negative sentinel lymph nodes. This description of the Schauta-Amreich radical vaginal hysterectomy technique with a video file could support the teaching of a procedure that may gain in popularity.

Laparoendoscopic Single-site Radical Hysterectomy with Vaginal Closure and without Uterine Manipulator for FIGO IB1 Cervical Cancer

Minimally invasive surgery (MIS) for radical hysterectomy (RH) has been reported with inferior oncologic outcomes in the New England Journal of Medicine [1,2]. Some studies have suggested that the no-touch technique may be a useful procedure to prevent tumor spillage and improve survival. Therefore, we performed RH targeting early-stage cervical cancer using the laparoendoscopic single-site (LESS) approach with an enclosed colpotomy and without a uterine manipulator [3]. Video demonstration of the technique. A hospital. A 48-year-old postmenopausal woman received a diagnosis of stage IB1 (International Federation of Gynecology and Obstetrics, 2018) cervical cancer [4]. After being fully informed of the benefits and risks of different surgical approaches (laparotomy and MIS), she consented to the MIS. The type C RH through the LESS approach was performed successfully. The final pathologic findings confirmed stage IB1 cervical carcinoma. The patient recovered quickly, albeit with slight pain, and the incision scar was hidden perfectly for cosmetic purposes. This video demonstrates that LESS-RH with vaginal closure and without a manipulator is feasible and safe. Suspension skills played a significant role in LESS-RH. In addition, this surgical procedure involved 4 specific techniques to prevent tumor spillage: creation of a vaginal cuff, avoidance of a uterine manipulator, standard type C radical hysterectomy, and bagging of the specimen. These adaptations were meant to minimize tumor manipulation and disruption for reducing the increased risk of recurrence. However, further verifications are still required.

Minimally invasive surgery versus laparotomy for radical hysterectomy in the management of early-stage cervical cancer: Survival outcomes

ObjectiveTo compare oncologic and perioperative outcomes in patients who underwent minimally invasive surgery (MIS) compared to laparotomy for newly diagnosed early-stage cervical carcinoma. MethodsWe retrospectively identified patients who underwent radical hysterectomy for stage IA1 with lymphovascular invasion (LVI), IA2, or IB1 cervical carcinoma at our institution from 1/2007–12/2017. Clinicopathologic characteristics and surgical and oncologic survival outcomes were compared using appropriate statistical testing. Multivariable Cox regression analysis was used to control for potential confounders. ResultsWe identified 196 evaluable cases—117 MIS (106 robotic [90.6%]) and 79 laparotomy cases. Cohorts had similar age, BMI, substage, histologic subtype, clinical and pathologic tumor size, positive margins, and presence of LVI. The MIS group had more cases with no residual tumor in the hysterectomy (24.8% vs. 10.1%, P = 0.01). The laparotomy group had more cases with positive nodes (29.1% vs. 17.1%, P = 0.046) and more patients who received adjuvant therapy (53.2% vs. 33.3%, P = 0.006). Median follow-up was ~4 years. Five-year disease-free survival (DFS) rates were 87.0% in the MIS group and 86.6% in the laparotomy group (P = 0.92); 5-year disease-specific survival (DSS) rates were 96.5% and 93.9%, respectively (P = 0.93); and 5-year overall survival (OS) rates were 96.5% and 87.4%, respectively (P = 0.15). MIS was not associated with DFS, DSS, or OS on multivariable regression analysis. The rate of postoperative complications was significantly lower in the MIS cohort (11.1% vs. 20.3%; P = 0.04). ConclusionsMIS radical hysterectomy for cervical carcinoma did not confer worse oncologic outcomes in our single-center and concurrent series of patients with early-stage cervical carcinoma.

Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer

BackgroundMinimally invasive surgery was adopted as an alternative to laparotomy (open surgery) for radical hysterectomy in patients with early-stage cervical cancer before high-quality evidence regarding its effect on survival was available. We sought to determine the effect of minimally invasive surgery on all-cause mortality among women undergoing radical hysterectomy for cervical cancer.MethodsWe performed a cohort study involving women who underwent radical hysterectomy for stage IA2 or IB1 cervical cancer during the 2010–2013 period at Commission on Cancer–accredited hospitals in the United States. The study used inverse probability of treatment propensity-score weighting. We also conducted an interrupted time-series analysis involving women who underwent radical hysterectomy for cervical cancer during the 2000–2010 period, using the Surveillance, Epidemiology, and End Results program database.ResultsIn the primary analysis, 1225 of 2461 women (49.8%) underwent minimally invasive surgery. Women treated with minimally invasive surgery were more often white, privately insured, and from ZIP Codes with higher socioeconomic status, had smaller, lower-grade tumors, and were more likely to have received a diagnosis later in the study period than women who underwent open surgery. Over a median follow-up of 45 months, the 4-year mortality was 9.1% among women who underwent minimally invasive surgery and 5.3% among those who underwent open surgery (hazard ratio, 1.65; 95% confidence interval [CI], 1.22 to 2.22; P=0.002 by the log-rank test). Before the adoption of minimally invasive radical hysterectomy (i.e., in the 2000–2006 period), the 4-year relative survival rate among women who underwent radical hysterectomy for cervical cancer remained stable (annual percentage change, 0.3%; 95% CI, −0.1 to 0.6). The adoption of minimally invasive surgery coincided with a decline in the 4-year relative survival rate of 0.8% (95% CI, 0.3 to 1.4) per year after 2006 (P=0.01 for change of trend).ConclusionsIn an epidemiologic study, minimally invasive radical hysterectomy was associated with shorter overall survival than open surgery among women with stage IA2 or IB1 cervical carcinoma. (Funded by the National Cancer Institute and others.)

Comparison of survival outcomes between radical hysterectomy and definitive radiochemotherapy in stage IB1 and IIA1 cervical cancer.

IntroductionThere is an ongoing debate regarding the optimal local treatment modalities for stage IB1 and IIA1 cervical cancer. The aim of this study was to determine whether radical hysterectomy or definitive radiochemotherapy is superior in stage IB1 and IIA1 cervical squamous cell carcinoma (SCC).MethodsFrom 1990 to 2010, a total of 3,769 patients with stage IB1 and IIA1 cervical SCC were included from the Surveillance, Epidemiology, and End Results database and were stratified according to whether they received radical hysterectomy or primary radiochemotherapy. Propensity score-matching (PSM) methods were used to balance patient baseline characteristics. Cancer-specific survival (CSS) and overall survival (OS) were compared between the two groups.ResultsOf the 3,769 patients, 3,653 (96.9%) and 116 (3.1%) patients received radical hysterectomy and definitive radiochemotherapy, respectively. Radiochemotherapy was rarely used for definitive treatment prior to 2000. Before PSM, patients who were older, of black ethnicity, and with larger tumor size and stage IIA1 disease were more likely to receive definitive radiochemotherapy. A total of 116 pairs were completely matched using PSM. The local treatment modalities had no effect on CSS or OS in either unmatched or matched populations. In the matched population, the 8-year CSS rates were 82.1% and 76.5% in surgery and radiochemotherapy groups, respectively (p=0.382). The 8-year OS rates were 74.6% and 67.8% in surgery and radiochemotherapy groups, respectively (p=0.205).ConclusionOur population-based study suggests that there is no clear local treatment of choice on survival outcomes between radical hysterectomy and definitive radiochemotherapy in patients with stage IB1 and IIA1 cervical SCC.

The Value of Diffusion-Weighted Imaging in Combination With Conventional Magnetic Resonance Imaging for Improving Tumor Detection for Early Cervical Carcinoma Treated With Fertility-Sparing Surgery.

This study aimed to investigate the value of diffusion-weighted imaging (DWI) in combination with conventional magnetic resonance imaging (MRI) for improving tumor detection in young patients treated with fertility-sparing surgery because of early cervical carcinoma. Fifty-four patients with stage Ia or Ib1 cervical carcinoma were enrolled into this study. Magnetic resonance examinations were performed for these patients using conventional MRI (including T1-weighted imaging, T2-weighted imaging, and dynamic contrast-enhanced MRI) and DWI. The apparent diffusion coefficient (ADC) values of cervical carcinoma were analyzed quantitatively and compared with that of adjacent epithelium. Sensitivity, positive predictive value, and accuracy of 2 sets of MRI sequences were calculated on the basis of histologic results, and the diagnostic ability of conventional MRI/DWI combinations was compared with that of conventional MRI. The mean ADC value from cervical carcinoma (mean, 786 × 10 mm/s ± 100) was significantly lower than that from adjacent epithelium (mean, 1352 × 10 mm/s ± 147) (P = 0.01). When the threshold ADC value set as 1010 × 10 mm/s, the sensitivity and specificity for differentiating cervical carcinoma from nontumor epithelium were 78.2% and 67.2%, respectively. The sensitivity and accuracy of conventional MRI for tumor detection were 76.0% and 70.4%, whereas the sensitivity and accuracy of conventional MRI/DWI combinations were 91.7% and 90.7%, respectively. Conventional MRI/DWI combinations revealed a positive predictive value of 97.8% and only 4 false-negative findings. The addition of DWI to conventional MRI considerably improves the sensitivity and accuracy of tumor detection in young patients treated with fertility-sparing surgery, which supports the inclusion quantitative analysis of ADC value in routine MRI protocol before fertility-sparing surgery.

FIGO stage IB1 cervical carcinoma: Place and principles of brachytherapy

FIGO stage IB1 cervical carcinoma: Place and principles of brachytherapy