Survival associated with extent of radical hysterectomy in
early-stage cervical cancer: a subanalysis of the Surveillance
in Cervical CANcer (SCCAN) collaborative study

J 2023

Survival associated with extent of radical hysterectomy in early-stage cervical cancer: a subanalysis of the Surveillance in Cervical CANcer (SCCAN) collaborative study

BIZZARRI, Nicolò, Denis QUERLEU, Lukáš DOSTÁLEK, Luc R C W VAN LONKHUIJZEN, Diana GIANNARELLI et. al.

Basic information

Original name

Survival associated with extent of radical hysterectomy in early-stage cervical cancer: a subanalysis of the Surveillance in Cervical CANcer (SCCAN) collaborative study

Authors

BIZZARRI, Nicolò, Denis QUERLEU, Lukáš DOSTÁLEK (203 Czech Republic), Luc R C W VAN LONKHUIJZEN, Diana GIANNARELLI, Aldo LOPEZ, Sahar SALEHI, Ali AYHAN, Sarah H KIM, David Isla ORTIZ, Jaroslav KLAT (203 Czech Republic), Fabio LANDONI, Rene PAREJA, Ranjit MANCHANDA, Jan KOSŤUN, Pedro T RAMIREZ, Mehmet M MEYDANLI, Diego ODETTO, Rene LAKY, Ignacio ZAPARDIEL, Vít WEINBERGER (203 Czech Republic, belonging to the institution), Ricardo Dos REIS, Luigi Pedone ANCHORA, Karina AMARO, Huseyin AKILLI, Nadeem R ABU-RUSTUM, Rosa A SALCEDO-HERNÁNDEZ, Veronika JAVŮRKOVÁ (203 Czech Republic), Constantijne H MOM, Giovanni SCAMBIA, Henrik FALCONER and David CIBULA (203 Czech Republic)

Edition

American journal of obstetrics and gynecology, NEW YORK, ELSEVIER, 2023, 0002-9378

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30214 Obstetrics and gynaecology

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 9.800 in 2022

RIV identification code

RIV/00216224:14110/23:00131349

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.ajog.2023.06.030

UT WoS

001103265500001

Keywords in English

cervical cancer; early stage; laparotomy; radical hysterectomy; radicality; surgery; survival

Abstract

V originále

Background: International guidelines recommend tailoring the radicality of hysterectomy according to the known preoperative tumor characteristics in patients with early-stage cervical cancer. Objective: This study aimed to assess whether increased radicality had an effect on 5-year disease-free survival in patients with early-stage cervical cancer undergoing radical hysterectomy. The secondary aims were 5-year overall survival and pattern of recurrence. Study design: This was an international, multicenter, retrospective study from the Surveillance in Cervical CANcer (SCCAN) collaborative cohort. Patients with the International Federation of Gynecology and Obstetrics 2009 stage IB1 and IIA1 who underwent open type B/C1/C2 radical hysterectomy according to Querleu-Morrow classification between January 2007 and December 2016, who did not undergo neoadjuvant chemotherapy and who had negative lymph nodes and free surgical margins at final histology, were included. Descriptive statistics and survival analyses were performed. Patients were stratified according to pathologic tumor diameter. Propensity score match analysis was performed to balance baseline characteristics in patients undergoing nerve-sparing and non-nerve-sparing radical hysterectomy. Results: A total of 1257 patients were included. Of note, 883 patients (70.2%) underwent nerve-sparing radical hysterectomy, and 374 patients (29.8%) underwent non-nerve-sparing radical hysterectomy. Baseline differences between the study groups were found for tumor stage and diameter (higher use of non-nerve-sparing radical hysterectomy for tumors >2 cm or with vaginal involvement; P<.0001). The use of adjuvant therapy in patients undergoing nerve-sparing and non-nerve-sparing radical hysterectomy was 27.3% vs 28.6%, respectively (P=.63). Five-year disease-free survival in patients undergoing nerve-sparing vs non-nerve-sparing radical hysterectomy was 90.1% (95% confidence interval, 87.9-92.2) vs 93.8% (95% confidence interval, 91.1-96.5), respectively (P=.047). Non-nerve-sparing radical hysterectomy was independently associated with better disease-free survival at multivariable analysis performed on the entire cohort (hazard ratio, 0.50; 95% confidence interval, 0.31-0.81; P=.004). Furthermore, 5-year overall survival in patients undergoing nerve-sparing vs non-nerve-sparing radical hysterectomy was 95.7% (95% confidence interval, 94.1-97.2) vs non-nerve-sparing 96.5% (95% confidence interval, 94.3-98.7), respectively (P=.78). In patients with a tumor diameter ≤20 mm, 5-year disease-free survival was 94.7% in nerve-sparing radical hysterectomy vs 96.2% in non-nerve-sparing radical hysterectomy (P=.22). In patients with tumors between 21 and 40 mm, 5-year disease-free survival was 90.3% in non-nerve-sparing radical hysterectomy vs 83.1% in nerve-sparing radical hysterectomy (P=.016) (no significant difference in the rate of adjuvant treatment in this subgroup, P=.47). This was confirmed after propensity match score analysis (balancing the 2 study groups). The pattern of recurrence in the propensity-matched population did not demonstrate any difference (P=.70). Conclusion: For tumors ≤20 mm, no survival difference was found with more radical hysterectomy. For tumors between 21 and 40 mm, a more radical hysterectomy was associated with improved 5-year disease-free survival. No difference in the pattern of recurrence according to the extent of radicality was observed. Non-nerve-sparing radical hysterectomy was associated with better 5-year disease-free survival than nerve-sparing radical hysterectomy after propensity score match analysis.

Citovat

BIZZARRI, Nicolò, Denis QUERLEU, Lukáš DOSTÁLEK, Luc R C W VAN LONKHUIJZEN, Diana GIANNARELLI, Aldo LOPEZ, Sahar SALEHI, Ali AYHAN, Sarah H KIM, David Isla ORTIZ, Jaroslav KLAT, Fabio LANDONI, Rene PAREJA, Ranjit MANCHANDA, Jan KOSŤUN, Pedro T RAMIREZ, Mehmet M MEYDANLI, Diego ODETTO, Rene LAKY, Ignacio ZAPARDIEL, Vít WEINBERGER, Ricardo Dos REIS, Luigi Pedone ANCHORA, Karina AMARO, Huseyin AKILLI, Nadeem R ABU-RUSTUM, Rosa A SALCEDO-HERNÁNDEZ, Veronika JAVŮRKOVÁ, Constantijne H MOM, Giovanni SCAMBIA, Henrik FALCONER and David CIBULA. Survival associated with extent of radical hysterectomy in early-stage cervical cancer: a subanalysis of the Surveillance in Cervical CANcer (SCCAN) collaborative study. American journal of obstetrics and gynecology. NEW YORK: ELSEVIER, 2023, vol. 229, No 4, p. "428e1"-"428e12", 12 pp. ISSN 0002-9378. Available from: https://dx.doi.org/10.1016/j.ajog.2023.06.030.

@article{2300442,
   author = {Bizzarri, Nicolò and Querleu, Denis and Dostálek, Lukáš and van Lonkhuijzen, Luc R C W and Giannarelli, Diana and Lopez, Aldo and Salehi, Sahar and Ayhan, Ali and Kim, Sarah H and Ortiz, David Isla and Klat, Jaroslav and Landoni, Fabio and Pareja, Rene and Manchanda, Ranjit and Kosťun, Jan and Ramirez, Pedro T and Meydanli, Mehmet M and Odetto, Diego and Laky, Rene and Zapardiel, Ignacio and Weinberger, Vít and Reis, Ricardo Dos and Anchora, Luigi Pedone and Amaro, Karina and Akilli, Huseyin and AbuandRustum, Nadeem R and SalcedoandHernández, Rosa A and Javůrková, Veronika and Mom, Constantijne H and Scambia, Giovanni and Falconer, Henrik and Cibula, David},
   article_location = {NEW YORK},
   article_number = {4},
   doi = {http://dx.doi.org/10.1016/j.ajog.2023.06.030},
   keywords = {cervical cancer; early stage; laparotomy; radical hysterectomy; radicality; surgery; survival},
   language = {eng},
   issn = {0002-9378},
   journal = {American journal of obstetrics and gynecology},
   title = {Survival associated with extent of radical hysterectomy in early-stage cervical cancer: a subanalysis of the Surveillance in Cervical CANcer (SCCAN) collaborative study},
   url = {https://www.sciencedirect.com/science/article/pii/S0002937823004222?via%3Dihub},
   volume = {229},
   year = {2023}
}

TY  - JOUR
ID  - 2300442
AU  - Bizzarri, Nicolò - Querleu, Denis - Dostálek, Lukáš - van Lonkhuijzen, Luc R C W - Giannarelli, Diana - Lopez, Aldo - Salehi, Sahar - Ayhan, Ali - Kim, Sarah H - Ortiz, David Isla - Klat, Jaroslav - Landoni, Fabio - Pareja, Rene - Manchanda, Ranjit - Kosťun, Jan - Ramirez, Pedro T - Meydanli, Mehmet M - Odetto, Diego - Laky, Rene - Zapardiel, Ignacio - Weinberger, Vít - Reis, Ricardo Dos - Anchora, Luigi Pedone - Amaro, Karina - Akilli, Huseyin - Abu-Rustum, Nadeem R - Salcedo-Hernández, Rosa A - Javůrková, Veronika - Mom, Constantijne H - Scambia, Giovanni - Falconer, Henrik - Cibula, David
PY  - 2023
TI  - Survival associated with extent of radical hysterectomy in early-stage cervical cancer: a subanalysis of the Surveillance in Cervical CANcer (SCCAN) collaborative study
JF  - American journal of obstetrics and gynecology
VL  - 229
IS  - 4
SP  - "428e1"-"428e12"
EP  - "428e1"-"428e12"
PB  - ELSEVIER
SN  - 00029378
KW  - cervical cancer
KW  - early stage
KW  - laparotomy
KW  - radical hysterectomy
KW  - radicality
KW  - surgery
KW  - survival
UR  - https://www.sciencedirect.com/science/article/pii/S0002937823004222?via%3Dihub
N2  - Background: International guidelines recommend tailoring the radicality of hysterectomy according to the known preoperative tumor characteristics in patients with early-stage cervical cancer. Objective: This study aimed to assess whether increased radicality had an effect on 5-year disease-free survival in patients with early-stage cervical cancer undergoing radical hysterectomy. The secondary aims were 5-year overall survival and pattern of recurrence. Study design: This was an international, multicenter, retrospective study from the Surveillance in Cervical CANcer (SCCAN) collaborative cohort. Patients with the International Federation of Gynecology and Obstetrics 2009 stage IB1 and IIA1 who underwent open type B/C1/C2 radical hysterectomy according to Querleu-Morrow classification between January 2007 and December 2016, who did not undergo neoadjuvant chemotherapy and who had negative lymph nodes and free surgical margins at final histology, were included. Descriptive statistics and survival analyses were performed. Patients were stratified according to pathologic tumor diameter. Propensity score match analysis was performed to balance baseline characteristics in patients undergoing nerve-sparing and non-nerve-sparing radical hysterectomy. Results: A total of 1257 patients were included. Of note, 883 patients (70.2%) underwent nerve-sparing radical hysterectomy, and 374 patients (29.8%) underwent non-nerve-sparing radical hysterectomy. Baseline differences between the study groups were found for tumor stage and diameter (higher use of non-nerve-sparing radical hysterectomy for tumors >2 cm or with vaginal involvement; P<.0001). The use of adjuvant therapy in patients undergoing nerve-sparing and non-nerve-sparing radical hysterectomy was 27.3% vs 28.6%, respectively (P=.63). Five-year disease-free survival in patients undergoing nerve-sparing vs non-nerve-sparing radical hysterectomy was 90.1% (95% confidence interval, 87.9-92.2) vs 93.8% (95% confidence interval, 91.1-96.5), respectively (P=.047). Non-nerve-sparing radical hysterectomy was independently associated with better disease-free survival at multivariable analysis performed on the entire cohort (hazard ratio, 0.50; 95% confidence interval, 0.31-0.81; P=.004). Furthermore, 5-year overall survival in patients undergoing nerve-sparing vs non-nerve-sparing radical hysterectomy was 95.7% (95% confidence interval, 94.1-97.2) vs non-nerve-sparing 96.5% (95% confidence interval, 94.3-98.7), respectively (P=.78). In patients with a tumor diameter ≤20 mm, 5-year disease-free survival was 94.7% in nerve-sparing radical hysterectomy vs 96.2% in non-nerve-sparing radical hysterectomy (P=.22). In patients with tumors between 21 and 40 mm, 5-year disease-free survival was 90.3% in non-nerve-sparing radical hysterectomy vs 83.1% in nerve-sparing radical hysterectomy (P=.016) (no significant difference in the rate of adjuvant treatment in this subgroup, P=.47). This was confirmed after propensity match score analysis (balancing the 2 study groups). The pattern of recurrence in the propensity-matched population did not demonstrate any difference (P=.70). Conclusion: For tumors ≤20 mm, no survival difference was found with more radical hysterectomy. For tumors between 21 and 40 mm, a more radical hysterectomy was associated with improved 5-year disease-free survival. No difference in the pattern of recurrence according to the extent of radicality was observed. Non-nerve-sparing radical hysterectomy was associated with better 5-year disease-free survival than nerve-sparing radical hysterectomy after propensity score match analysis.
ER  -

BIZZARRI, Nicolò, Denis QUERLEU, Lukáš DOSTÁLEK, Luc R C W VAN LONKHUIJZEN, Diana GIANNARELLI, Aldo LOPEZ, Sahar SALEHI, Ali AYHAN, Sarah H KIM, David Isla ORTIZ, Jaroslav KLAT, Fabio LANDONI, Rene PAREJA, Ranjit MANCHANDA, Jan KOSŤUN, Pedro T RAMIREZ, Mehmet M MEYDANLI, Diego ODETTO, Rene LAKY, Ignacio ZAPARDIEL, Vít WEINBERGER, Ricardo Dos REIS, Luigi Pedone ANCHORA, Karina AMARO, Huseyin AKILLI, Nadeem R ABU-RUSTUM, Rosa A SALCEDO-HERNÁNDEZ, Veronika JAVŮRKOVÁ, Constantijne H MOM, Giovanni SCAMBIA, Henrik FALCONER and David CIBULA. Survival associated with extent of radical hysterectomy in early-stage cervical cancer: a subanalysis of the Surveillance in Cervical CANcer (SCCAN) collaborative study. \textit{American journal of obstetrics and gynecology}. NEW YORK: ELSEVIER, 2023, vol.~229, No~4, p.~''428e1''-''428e12'', 12 pp. ISSN~0002-9378. Available from: https://dx.doi.org/10.1016/j.ajog.2023.06.030.

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