According to a recent study published in the American Journal of Obstetrics & Gynecology, there is an association between the extent of radical hysterectomy (RH) and the odds of survival in patients with early-stage cervical cancer.
Takeaways
- A recent study published in the American Journal of Obstetrics & Gynecology highlights an association between the extent of radical hysterectomy (RH) and the odds of survival in patients with early-stage cervical cancer.
- Cervical cancer ranks as the fourth most common cancer diagnosis in women worldwide, emphasizing its significant health burden.
- The study underscores the importance of determining surgical radicality based on preoperative risk stratification, balancing the potential improvement in survivability with the risk of increased intra- and postoperative morbidities.
- There is limited available data on the prognostic effects of more versus less radical hysterectomy in early-stage cervical cancer patients, highlighting the need for further research in this area.
- The study reported high rates of 5-year disease-free survival (DFS) among participants who received RH, suggesting the effectiveness of this treatment approach.
Cervical cancer is the fourth most common cancer diagnosis in women worldwide, making it a major burden. In early stages, cervical cancer is often treated through RH with sentinel lymph node biopsy and pelvic lymphadenectomy.
The surgical radicality should be determined based on preoperative risk stratification. Surgery with increased radicality is often conducted to remove occult parametrial disease. This is projected to improve survivability but increase intra- and postoperative morbidities.
There is little data on the prognostic effect of more vs less RH in early-stage cervical cancer. To address this information gap, investigators conducted a study evaluating the 5-year disease-free survival (DFS) following RH in patients with early-stage cervical cancer.
The Surveillance in Cervical, an international, multicenter, retrospective cohort study consisting of 20 tertiary centers with a significant number of cervical cancer cases, was evaluated for participants. The pathologic tumor diameter, defined as the largest tumor diameter on the hysterectomy specimen, was measured in included patients.
Eligibility criteria included being treated for histologically confirmed cervical cancer from January 2007 to December 2006, Tumour, Node, Metastasis stage T1a to T2b, primary surgical management, and negative surgical margins.
Participants underwent type B or C1/C2 RH, determined by the Querleu-Morrow classification. Only patients receiving open RH were included because minimally invasive RH has been associated with worse odds of survival.
Surgery type was determined by the attending surgeon’s preference. Type B RH involved resection of the paracervix, while type C RH involved transection of the paracervix. Both surgery types occurred at the paracervix’s junction with the internal iliac vascular system.
There were 1257 patients included in the final analysis, 70.2% received nerve-sparing RH and 29.8% non–nerve-sparing RH. International Federation of Gynecology and Obstetrics 2009 stage IB1 was diagnosed in 94.4% of participants, squamous cell carcinoma in 65.5%, grade 2 lymphovascular space invasion (LVSI) in 69.8%, and negative LVSI in 47.7%.
The median follow-up time was 5.3 years, with 5-year DFS in 91.5% of participants and overall survival (OS) in 96%. Recurrence was reported in 8.8% of patients and death in 4.4%. The 5-year DFS rate was 90.1% in patients receiving nerve-sparing RH and 93.8% in patients receiving non-nerve-sparing RH. OS did not differ between the 2 groups.
These results indicated high rates of survivability among patients receiving RH. Investigators recommended further research focus on the role of more extended radicality to treat large and high-risk tumors.
Reference
Bizzarri N, Querleu D, Dostálek L. Survival associated with extent of radical hysterectomy in early-stage cervical cancer: a subanalysis of the Surveillance in Cervical CANcer (SCCAN) collaborative study. American Journal of Obstetrics & Gynecology. 2023;229(4):428.E1-426.E4. doi:10.1016/j.ajog.2023.06.030
