Fertility-sparing trachelectomy for early-stage cervical cancer: A proposal of an ideal candidate

Hiroko Machida, Takashi Iwata, Kaoru Okugawa, Koji Matsuo, Tsuyoshi Saito, Kyoko Tanaka, Kenichiro Morishige, Hiroaki Kobayashi, Kiyoshi Yoshino, Hideki Tokunaga, Tomoaki Ikeda, Makio Shozu, Nobuo Yaegashi, Takayuki Enomoto, Mikio Mikami

Research output: Contribution to journalArticle

Abstract

Objective: To propose an ideal patient candidate with early-stage cervical cancer for undergoing fertility-sparing trachelectomy. Methods: This nationwide, multicenter, retrospective study was conducted by the Japan Society of Obstetrics and Gynecology involving women aged <45 years with clinical stage I-II cervical cancer who had planned fertility-sparing trachelectomy and pelvic lymphadenectomy between 2009 and 2013 (n = 393). Ideal candidates were defined to have a tumor size of ≤2 cm, no lymph node metastasis, no deep stromal invasion, and no high-risk histology (n = 284, 69.6%). Less-ideal candidates were defined to have any one of these four characteristics (n = 109, 30.4%). Propensity score inverse probability of treatment weighting was used to assess survival outcomes. Results: Less-ideal candidates were more likely to undergo hysterectomy conversion (22.9% versus 3.2%), receive postoperative radiotherapy (11.9% versus 0.4%), or chemotherapy (32.1% versus 3.2%) compared with ideal candidates (all, P < 0.05). The weighted model revealed that among those who underwent trachelectomy (ideal candidates, n = 275 and less-ideal candidates, n = 84), less-ideal candidates had significantly decreased disease-free survival (5-year rates: 85.5% versus 95.5%; HR 3.93, 95% CI 1.99–7.74; P < 0.001) and cause-specific survival (92.5% versus 98.6%; HR 5.47, 95% CI 1.68–17.8, P = 0.001) compared with ideal candidates. Similarly, less-ideal candidates were significantly associated with decreased disease-free survival compared with ideal candidates among those who were young age, had small tumors or squamous histology, and underwent surgery alone (all, P < 0.05). Conclusion: Less-ideal candidates had approximately four-fold higher recurrence risk and cancer mortality compared with ideal candidates. Ideal candidates for fertility-sparing trachelectomy for early-stage cervical cancer proposed in our study may be useful as the future framework for developing guidelines for fertility-sparing trachelectomy in Japan.

Original languageEnglish
JournalGynecologic Oncology
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Uterine Cervical Neoplasms
Fertility
Disease-Free Survival
Histology
Japan
Neoplasms
Propensity Score
Survival
Lymph Node Excision
Hysterectomy
Gynecology
Obstetrics
Multicenter Studies
Radiotherapy
Retrospective Studies
Lymph Nodes
Trachelectomy
Guidelines
Neoplasm Metastasis
Recurrence

All Science Journal Classification (ASJC) codes

  • Oncology
  • Obstetrics and Gynaecology

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Fertility-sparing trachelectomy for early-stage cervical cancer : A proposal of an ideal candidate. / Machida, Hiroko; Iwata, Takashi; Okugawa, Kaoru; Matsuo, Koji; Saito, Tsuyoshi; Tanaka, Kyoko; Morishige, Kenichiro; Kobayashi, Hiroaki; Yoshino, Kiyoshi; Tokunaga, Hideki; Ikeda, Tomoaki; Shozu, Makio; Yaegashi, Nobuo; Enomoto, Takayuki; Mikami, Mikio.

In: Gynecologic Oncology, 01.01.2019.

Research output: Contribution to journalArticle

Machida, H, Iwata, T, Okugawa, K, Matsuo, K, Saito, T, Tanaka, K, Morishige, K, Kobayashi, H, Yoshino, K, Tokunaga, H, Ikeda, T, Shozu, M, Yaegashi, N, Enomoto, T & Mikami, M 2019, 'Fertility-sparing trachelectomy for early-stage cervical cancer: A proposal of an ideal candidate', Gynecologic Oncology. https://doi.org/10.1016/j.ygyno.2019.11.021
Machida, Hiroko ; Iwata, Takashi ; Okugawa, Kaoru ; Matsuo, Koji ; Saito, Tsuyoshi ; Tanaka, Kyoko ; Morishige, Kenichiro ; Kobayashi, Hiroaki ; Yoshino, Kiyoshi ; Tokunaga, Hideki ; Ikeda, Tomoaki ; Shozu, Makio ; Yaegashi, Nobuo ; Enomoto, Takayuki ; Mikami, Mikio. / Fertility-sparing trachelectomy for early-stage cervical cancer : A proposal of an ideal candidate. In: Gynecologic Oncology. 2019.
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abstract = "Objective: To propose an ideal patient candidate with early-stage cervical cancer for undergoing fertility-sparing trachelectomy. Methods: This nationwide, multicenter, retrospective study was conducted by the Japan Society of Obstetrics and Gynecology involving women aged <45 years with clinical stage I-II cervical cancer who had planned fertility-sparing trachelectomy and pelvic lymphadenectomy between 2009 and 2013 (n = 393). Ideal candidates were defined to have a tumor size of ≤2 cm, no lymph node metastasis, no deep stromal invasion, and no high-risk histology (n = 284, 69.6{\%}). Less-ideal candidates were defined to have any one of these four characteristics (n = 109, 30.4{\%}). Propensity score inverse probability of treatment weighting was used to assess survival outcomes. Results: Less-ideal candidates were more likely to undergo hysterectomy conversion (22.9{\%} versus 3.2{\%}), receive postoperative radiotherapy (11.9{\%} versus 0.4{\%}), or chemotherapy (32.1{\%} versus 3.2{\%}) compared with ideal candidates (all, P < 0.05). The weighted model revealed that among those who underwent trachelectomy (ideal candidates, n = 275 and less-ideal candidates, n = 84), less-ideal candidates had significantly decreased disease-free survival (5-year rates: 85.5{\%} versus 95.5{\%}; HR 3.93, 95{\%} CI 1.99–7.74; P < 0.001) and cause-specific survival (92.5{\%} versus 98.6{\%}; HR 5.47, 95{\%} CI 1.68–17.8, P = 0.001) compared with ideal candidates. Similarly, less-ideal candidates were significantly associated with decreased disease-free survival compared with ideal candidates among those who were young age, had small tumors or squamous histology, and underwent surgery alone (all, P < 0.05). Conclusion: Less-ideal candidates had approximately four-fold higher recurrence risk and cancer mortality compared with ideal candidates. Ideal candidates for fertility-sparing trachelectomy for early-stage cervical cancer proposed in our study may be useful as the future framework for developing guidelines for fertility-sparing trachelectomy in Japan.",
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AU - Machida, Hiroko

AU - Iwata, Takashi

AU - Okugawa, Kaoru

AU - Matsuo, Koji

AU - Saito, Tsuyoshi

AU - Tanaka, Kyoko

AU - Morishige, Kenichiro

AU - Kobayashi, Hiroaki

AU - Yoshino, Kiyoshi

AU - Tokunaga, Hideki

AU - Ikeda, Tomoaki

AU - Shozu, Makio

AU - Yaegashi, Nobuo

AU - Enomoto, Takayuki

AU - Mikami, Mikio

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N2 - Objective: To propose an ideal patient candidate with early-stage cervical cancer for undergoing fertility-sparing trachelectomy. Methods: This nationwide, multicenter, retrospective study was conducted by the Japan Society of Obstetrics and Gynecology involving women aged <45 years with clinical stage I-II cervical cancer who had planned fertility-sparing trachelectomy and pelvic lymphadenectomy between 2009 and 2013 (n = 393). Ideal candidates were defined to have a tumor size of ≤2 cm, no lymph node metastasis, no deep stromal invasion, and no high-risk histology (n = 284, 69.6%). Less-ideal candidates were defined to have any one of these four characteristics (n = 109, 30.4%). Propensity score inverse probability of treatment weighting was used to assess survival outcomes. Results: Less-ideal candidates were more likely to undergo hysterectomy conversion (22.9% versus 3.2%), receive postoperative radiotherapy (11.9% versus 0.4%), or chemotherapy (32.1% versus 3.2%) compared with ideal candidates (all, P < 0.05). The weighted model revealed that among those who underwent trachelectomy (ideal candidates, n = 275 and less-ideal candidates, n = 84), less-ideal candidates had significantly decreased disease-free survival (5-year rates: 85.5% versus 95.5%; HR 3.93, 95% CI 1.99–7.74; P < 0.001) and cause-specific survival (92.5% versus 98.6%; HR 5.47, 95% CI 1.68–17.8, P = 0.001) compared with ideal candidates. Similarly, less-ideal candidates were significantly associated with decreased disease-free survival compared with ideal candidates among those who were young age, had small tumors or squamous histology, and underwent surgery alone (all, P < 0.05). Conclusion: Less-ideal candidates had approximately four-fold higher recurrence risk and cancer mortality compared with ideal candidates. Ideal candidates for fertility-sparing trachelectomy for early-stage cervical cancer proposed in our study may be useful as the future framework for developing guidelines for fertility-sparing trachelectomy in Japan.

AB - Objective: To propose an ideal patient candidate with early-stage cervical cancer for undergoing fertility-sparing trachelectomy. Methods: This nationwide, multicenter, retrospective study was conducted by the Japan Society of Obstetrics and Gynecology involving women aged <45 years with clinical stage I-II cervical cancer who had planned fertility-sparing trachelectomy and pelvic lymphadenectomy between 2009 and 2013 (n = 393). Ideal candidates were defined to have a tumor size of ≤2 cm, no lymph node metastasis, no deep stromal invasion, and no high-risk histology (n = 284, 69.6%). Less-ideal candidates were defined to have any one of these four characteristics (n = 109, 30.4%). Propensity score inverse probability of treatment weighting was used to assess survival outcomes. Results: Less-ideal candidates were more likely to undergo hysterectomy conversion (22.9% versus 3.2%), receive postoperative radiotherapy (11.9% versus 0.4%), or chemotherapy (32.1% versus 3.2%) compared with ideal candidates (all, P < 0.05). The weighted model revealed that among those who underwent trachelectomy (ideal candidates, n = 275 and less-ideal candidates, n = 84), less-ideal candidates had significantly decreased disease-free survival (5-year rates: 85.5% versus 95.5%; HR 3.93, 95% CI 1.99–7.74; P < 0.001) and cause-specific survival (92.5% versus 98.6%; HR 5.47, 95% CI 1.68–17.8, P = 0.001) compared with ideal candidates. Similarly, less-ideal candidates were significantly associated with decreased disease-free survival compared with ideal candidates among those who were young age, had small tumors or squamous histology, and underwent surgery alone (all, P < 0.05). Conclusion: Less-ideal candidates had approximately four-fold higher recurrence risk and cancer mortality compared with ideal candidates. Ideal candidates for fertility-sparing trachelectomy for early-stage cervical cancer proposed in our study may be useful as the future framework for developing guidelines for fertility-sparing trachelectomy in Japan.

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