Increasing trends of cervical conization with lymph node evaluation for fertility-sparing surgery in early cervical cancer

Katelyn B Furey; Zachary S Anderson; Michelle L Kuznicki; Maximilian Klar; Lynda D Roman; Jason D Wright; Koji Matsuo

doi:10.1016/j.ygyno.2023.04.025

Increasing trends of cervical conization with lymph node evaluation for fertility-sparing surgery in early cervical cancer

Gynecol Oncol. 2023 Jun:173:122-129. doi: 10.1016/j.ygyno.2023.04.025. Epub 2023 May 1.

Authors

Katelyn B Furey¹, Zachary S Anderson¹, Michelle L Kuznicki², Maximilian Klar³, Lynda D Roman⁴, Jason D Wright⁵, Koji Matsuo⁶

Affiliations

¹ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
² Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA.
³ Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany.
⁴ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
⁵ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
⁶ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA. Electronic address: koji.matsuo@med.usc.edu.

PMID: 37137189
DOI: 10.1016/j.ygyno.2023.04.025

Abstract

Objective: To examine uptake, characteristics, and survival outcome of less-radical fertility-sparing surgery with cervical conization and lymph node evaluation (Cone-LN) in reproductive age patients with early cervical cancer.

Methods: This retrospective cohort study examined the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. The study population included 407 patients aged <50 years with stage IA-IB2 (≤4 cm) cervical cancer who received fertility-sparing surgery from 2004 to 2019. The exposure was fertility-sparing surgery type: Cone-LN (n = 196) or trachelectomy with lymph node evaluation (Trach-LN, n = 211). The main co-outcomes were (i) temporal trends of surgery type, assessed with Cochran-Armitage test, and (ii) clinical and tumor characteristics, assessed with multivariable binary logistic regression model. The secondary outcome was overall survival, assessed with inverse probability of treatment weighting propensity score.

Results: The number of patients receiving Cone-LN increased from 43.5% in 2004-2007 to 58.4% in 2016-2019 (P-trend = 0.005). Patients receiving conization and sentinel lymph node (SLN) biopsy alone increased from 0% to 14.4% (P-trend < 0.001). In a multivariable analysis, patients in the Cone-LN group were more likely to undergo SLN biopsy (aOR 6.04) compared to those in the Trach-LN group whereas those with adenocarcinoma (aOR 0.49) and T1b tumors (aOR for ≤2 cm 0.21, and aOR for 2.1-4.0 cm 0.10) were less likely to receive Cone-LN. In a propensity score-weighted model, the Cone-LN and Trach-LN groups had comparable overall survival (7-year rates, 98.9% vs 97.8%). Similar associations were observed for patients with squamous, adenocarcinoma / adenosquamous, T1a classification, and T1b(≤2 cm) classification.

Conclusion: The current population-based analysis suggests that the performance of cervical conization with lymph node evaluation, particularly with SLN biopsy, is gradually increasing for early cervical cancer patients desiring future fertility.

Keywords: Cervical cancer; Conization; Fertility sparing; Lymph node evaluation; Sentinel lymph node; Trachelectomy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adenocarcinoma* / pathology
Adenocarcinoma* / surgery
Conization / methods
Female
Humans
Lymph Node Excision / methods
Lymph Nodes / pathology
Lymph Nodes / surgery
Neoplasm Staging
Retrospective Studies
Sentinel Lymph Node Biopsy
Uterine Cervical Neoplasms* / pathology