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Am J Obstet Gynecol. 2018 Nov;219(5):461.e1-461.e18. doi: 10.1016/j.ajog.2018.08.020. Epub 2018 Aug 21.

Characteristics and outcomes of reproductive-aged women with early-stage cervical cancer: trachelectomy vs hysterectomy.

Author information

1
Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan.
2
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA.
3
Department of Obstetrics and Gynecology, Niigata University School of Medicine, Niigata, Japan.
4
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
5
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA.
6
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA.
7
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
8
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY.
9
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA. Electronic address: koji.matsuo@med.usc.edu.

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.

KEYWORDS:

cervical cancer; survival; trachelectomy; trend

PMID:
30138618
DOI:
10.1016/j.ajog.2018.08.020

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