Wait-time for hysterectomy and survival of women with early-stage cervical cancer: A clinical implication during the coronavirus pandemic

Objective. A global pandemic caused by a novel coronavirus (Covid-19) has created unique challenges to providing timely care for cancer patients. In early-stage cervical cancer, postponing hysterectomy for 6-8 weeks is suggested as a possible option in the Covid-19 burdened hospitals. Yet, literature examining the impact of surgerywait-time on survival in early-stage cervical cancer remains scarce. This study examined the association between surgery wait-time of 8 weeks and oncologic outcome in women with early-stage cervical cancer. Methods. This is a single institution retrospective observational study at a tertiary referral medical center examining womenwho underwent primary hysterectomy or trachelectomy for clinical stage IA-IIA invasive cervical cancer between 2000 and 2017 (N= 217). Wait-time fromthe diagnosis of invasive cervical cancer via biopsy to definitive surgery was categorized as: short wait-time (<8 weeks; n= 110) versus long wait-time (>= 8 weeks; n= 107). Propensity score inverse probability of treatment weightingwas used to balance the measured demographics between the two groups, and disease-free survival (DFS) and overall survival (OS) were assessed. A systematic literature review with meta-analysis was additionally performed. Results. In aweightedmodel (median follow-up, 4.6 years), women in the longwait-time group had DFS (4.5year rates, 91.2% versus 90.7%, hazard ratio [HR] 1.11, 95% confidence interval [CI] 0.47-2.59, P= 0.818) and OS (95.0% versus 97.4%, HR 1.47, 95%CI 0.50-4.31, P = 0.487) similar to those in the short wait-time group. Three studies were examined for meta-analysis, and a pooled HR for surgery wait-time of >= 8 weeks on DFS was 0.96 (95%CI 0.59-1.55). Conclusion. Our study suggests thatwait-time of 8weeks for hysterectomy may not be associatedwith shortterm disease recurrence in women with early-stage cervical cancer. (C) 2020 Elsevier Inc. All rights reserved.