Less versus more radical surgery in stage IB1 cervical cancer: A population-based study of long-term survival Journal Article


Authors: Tseng, J. H.; Aloisi, A.; Sonoda, Y.; Gardner, G. J.; Zivanovic, O.; Abu-Rustum, N. R.; Leitao, M. M. Jr
Article Title: Less versus more radical surgery in stage IB1 cervical cancer: A population-based study of long-term survival
Abstract: Background: Standard surgical treatment for women with stage IB1 cervical cancer consists of radical hysterectomy. This study assesses survival outcomes of those treated with less radical surgery (LRS; conization, trachelectomy, simple hysterectomy) compared to more radical surgery (MRS; modified radical, radical hysterectomy). Methods: Using the Surveillance, Epidemiology and End Results database, we identified women <45 years with FIGO stage IB1 cervical cancer diagnosed from 1/1998 to 12/2012. Only those who underwent lymph node (LN) assessment were analyzed. Disease-specific survivals (DSSs) of LRS were compared with those of MRS. Results: Of 2571 patients, 807 underwent LRS and 1764 underwent MRS, all with LN assessment. For LRS vs. MRS, 28% vs. 23% were diagnosed with adenocarcinoma (p = 0.024), 31% vs. 39% had G3 disease (p < 0.001), 40% vs. 45% had tumor size >2 cm (p < 0.001), and 27% vs. 29% received adjuvant radiation therapy (p = 0.005). Median follow-up was 79 months (range, 0–179). Ten-year DSS for LRS vs. MRS was 93.5% vs. 92.3% (p = 0.511). There was no difference in 10-year DSS when stratified by tumor size ≤2 cm (LRS 95.1% vs. MRS 95.6%, p = 0.80) or > 2 cm (LRS 90.1% vs. MRS 88.2%, p = 0.48). Factors independently associated with increased risk of death included adenosquamous histology (HR 2.37), G3 disease (HR 2.86), tumors >2 cm (HR 1.82), and LN positivity (HR 2.42). Compared to MRS, LRS was not associated with a higher risk of death. Conclusions: In a select group of young women with stage IB1 cervical cancer, LRS compared to MRS does not appear to compromise DSS. © 2018 Elsevier Inc.
Keywords: disease-specific survival; trachelectomy; radical hysterectomy; cervical cancer; conization; simple hysterectomy
Journal Title: Gynecologic Oncology
Volume: 150
Issue: 1
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2018-07-01
Start Page: 44
End Page: 49
Language: English
DOI: 10.1016/j.ygyno.2018.04.571
PROVIDER: scopus
PUBMED: 29776598
DOI/URL:
Notes: Article -- Export Date: 2 July 2018 -- Source: Scopus
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MSK Authors
  1. Ginger J Gardner
    140 Gardner
  2. Yukio Sonoda
    293 Sonoda
  3. Mario Leitao
    323 Leitao
  4. Oliver Zivanovic
    131 Zivanovic
  5. Jill   Tseng
    21 Tseng
  6. Alessia Aloisi
    13 Aloisi