Characteristics and outcomes of reproductive-aged women with early-stage cervical cancer: Trachelectomy vs hysterectomy Journal Article


Authors: Machida, H.; Mandelbaum, R. S.; Mikami, M.; Enomoto, T.; Sonoda, Y.; Grubbs, B. H.; Paulson, R. J.; Roman, L. D.; Wright, J. D.; Matsuo, K.
Article Title: Characteristics and outcomes of reproductive-aged women with early-stage cervical cancer: Trachelectomy vs hysterectomy
Abstract: Background: Trachelectomy is the treatment of choice for reproductive-aged women with early-stage cervical cancer who desire future fertility. Comprehensive population-based statistics have been missing to date. Objective: We sought to compare characteristics and survival of reproductive-aged women who underwent trachelectomy for early-stage cervical cancer to those who had hysterectomy. Study Design: This is a retrospective observational study examining the Surveillance, Epidemiology, and End Results program from 1998 through 2014. Women <45 years of age with stage IA and IB1 (tumor size ≤2 cm) cervical cancer who underwent trachelectomy were compared to those who underwent hysterectomy. Multivariable models were used to identify clinicopathological factors associated with trachelectomy. Survival was compared between the 2 groups after propensity score matching. Results: Among 6359 women, 190 (3.0%; 95% confidence interval, 2.6–3.4) underwent trachelectomy. The median age of the trachelectomy group was 31 years (interquartile range, 28–34). The proportion of women who underwent trachelectomy significantly increased during the study period (1.2% in 1998 through 2002, 3.0% in 2003 through 2008, and 4.5% in 2009 through 2014, P <.001). Younger age, nonblack race, single marital status, eastern registry area, recent disease diagnosis, nonsquamous histology, and higher stage were independent factors associated with trachelectomy use (all, adjusted P <.05). After propensity score matching, 5-year cause-specific survival (96.9% vs 96.6%; hazard ratio, 0.73; 95% confidence interval, 0.23–2.30; P =.59) and overall survival (96.1% vs 96.6%; hazard ratio, 0.76; 95% confidence interval, 0.26–2.20; P =.61) were similar between the trachelectomy group and the hysterectomy group. Conclusion: Our study found that there was a significant increase in the proportion of reproductive-aged women with stage IA or IB1 (≤2 cm) cervical cancer who underwent trachelectomy in recent years. Survival with trachelectomy was similar to those who had hysterectomy in this population. © 2018 Elsevier Inc.
Keywords: survival; adult; controlled study; major clinical study; overall survival; clinical feature; histopathology; cancer staging; outcome assessment; hysterectomy; retrospective study; age; register; early cancer; uterine cervix cancer; observational study; race difference; trachelectomy; cause specific survival; cervical cancer; medical history; comparative effectiveness; trend; cervicectomy; human; female; priority journal; article; single (marital status)
Journal Title: American Journal of Obstetrics and Gynecology
Volume: 219
Issue: 5
ISSN: 0002-9378
Publisher: Elsevier Inc.  
Date Published: 2018-11-01
Start Page: 461.e1
End Page: 461.e18
Language: English
DOI: 10.1016/j.ajog.2018.08.020
PUBMED: 30138618
PROVIDER: scopus
PMCID: PMC6648708
DOI/URL:
Notes: Article -- Export Date: 3 December 2018 -- Source: Scopus
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  1. Yukio Sonoda
    365 Sonoda