4.6 Article

Tumor Size and Oncological Outcomes in Patients with Early Cervical Cancer Treated by Fertility Preservation Surgery: A Multicenter Retrospective Cohort Study

Journal

CANCERS
Volume 14, Issue 9, Pages -

Publisher

MDPI
DOI: 10.3390/cancers14092108

Keywords

early cervical cancer; fertility-sparing surgery; tumor size

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The study aimed to analyze the impact of tumor size >= 2 cm on oncological outcomes of fertility-sparing surgery (FSS) in early cervical cancer in a Spanish cohort. Tumor size >= 2 cm was found to be the most important negative prognostic factor in this multicenter cohort of patients with early cervical cancer and gestational desire who underwent FSS in Spain. Rigorous selection criteria for fertility preservation are crucial, especially for patients with tumors larger than 2 cm, to achieve better oncological outcomes.
Simple Summary As cervical cancer is increasingly diagnosed in women who still intend to have children, fertility-sparing surgery is arising as a treatment option for those women with early-stage cervical cancer. The aim of this study was to analyze surgical, oncological and obstetrical outcomes of fertility-sparing surgery in early cervical cancer in Spain. In our study, the tumor size was the most important negative prognostic factor in fertility-sparing surgery (FSS) in cervical cancer. Selection criteria for fertility preservation should be rigorous, especially for patients with a tumor > 2 cm, due to the worse oncological outcomes associated with such tumors. Patients with an early cervical cancer tumor > 2 cm and a desire for pregnancy should be advised against primary FSS. Background: The aim of this study was to analyze the impact of tumor size > 2 cm on oncological outcomes of fertility-sparing surgery (FSS) in early cervical cancer in a Spanish cohort. Methods: A multicenter, retrospective cohort study of early cervical cancer (stage IA1 with lymphovascular space invasion -IB1 (FIGO 2009)) patients with gestational desire who underwent FSS at 12 tertiary departments of gynecology oncology between 01/2005 and 01/2019 throughout Spain. Results: A total of 111 patients were included, 82 (73.9%) with tumors < 2 cm and 29 (26.1%) with tumors 2-4 cm. Patients' characteristics were balanced except from lymphovascular space invasion. All were intraoperative lymph node-negative. Median follow-up was 55.7 and 30.7 months, respectively. Eleven recurrences were diagnosed (9.9%), five (6.0%) and six (21.4%) (p < 0.05). The 3-year progression-free survival (PFS) was 95.7% (95%CI 87.3-98.6) and 76.9% (95% CI 55.2-89.0) (p = 0.011). Only tumor size (<2 cm vs. 2-4 cm) was found to be significant for recurrence. After adjusting for the rest of the variables, tumor size 2-4 cm showed a Hazard Ratio of 5.99 (CI 95% 1.01-35.41, p = 0.036). Conclusions: Tumor size >= 2 cm is the most important negative prognostic factor in this multicenter cohort of patients with early cervical cancer and gestational desire who underwent FSS in Spain.

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