Conization and lymph node evaluation in low-risk cervical cancer. Is it time to avoid radical surgery? Retrospective series and literature review

Lucchini, Sergio Martin; Ferreyra, H; Landeros, Juan; Esteban, A; Donetch, G; Goldsman, Marcos G; Borla, Hernan F.; Heredia, Fernando Martínez

doi:10.1016/j.ejogrb.2021.09.017

Cited by 8 publications

(5 citation statements)

References 42 publications

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“…After removing 129 duplicate studies, the remaining 389 articles were screened based on titles and abstracts, and obviously ineligible articles were excluded, resulting in a total of 148 articles remaining. After reading the full texts, 17 studies that met the study criteria were eventually included in the analysis (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). The specific search process are detailed in Figure 1.…”

Section: Search Resultsmentioning

confidence: 99%

“…Among them, 138 women gave birth to at least one healthy baby. The combined live birth rate was 33.9% (95% CI, 0.261-0.422) (17)(18)(19)(20)(21)(22)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33), and the heterogeneity test result for the included studies was I 2 = 63.2 P < 0.05, indicating high heterogeneity among the included studies (Figure 5-1). Subgroup analysis showed no significant difference among subgroups.…”

Section: Live Birth Rate and Miscarriage Ratementioning

confidence: 99%

“…A total of 415 (72.93%) patients successfully received conization combined with pelvic node evaluation. Furthermore, 183 young women achieved at least one pregnancy, and the combined pregnancy rate was 45.4% (95% CI, 0.34-0.571) (17)(18)(19)(20)(21)(22)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). The heterogeneity test result for the included studies was I 2 = 81.0, P < 0.05 (Figure 4-1), indicating high heterogeneity among the included studies.…”

Section: Fertility and Oncologic Outcomes 341 Pregnancy Ratesmentioning

confidence: 99%

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Oncological and reproductive outcomes of conization combined with pelvic node evaluation in patients with early-stage cervical cancer: a systematic review and meta-analysis

Wang,

Chen,

Wang

et al. 2023

Front. Oncol.

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ObjectiveThis study aims to preliminarily assess the oncological and reproductive outcomes of fertility preservation treatment using conization combined with pelvic node evaluation in young patients with early-stage cervical cancer (ECC) through meta-analysis.MethodsIn this meta-analysis, we analyzed studies published in PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), International Clinical Trials Registry Platform (ICTRP), and Clinical Trials. gov that appeared in our search from inception to 0 7/02/2023.ResultsThere were 17 relevant studies with a total of 620 patients included, of which 444 patients received conization combined with pelvic node evaluation. The combined pregnancy rate was 45.4% (95% CI: 0.34–0.57), the combined live birth rate was 33.9% (95% CI: 0.26–0.42), the combined miscarriage rate was 4.8% (95% CI: 0.02–0.092), the combined preterm delivery rate was 5.1% (95% CI: 0.02–0.092), and the combined recurrence rate was 1.9% (95% CI: 0.006–0.035), which did not significantly differ from that of patients who received radical surgery (OR: 0.689, 95% CI: 0.506–0.938).ConclusionCervical conization combined with pelvic lymph node evaluation for fertility preservation in young ECC patients can achieve oncological outcomes similar to radical surgery while improving pregnancy success rates and preserving postoperative fertility. In summary, fertility preservation treatment using cervical conization combined with pelvic lymph node evaluation may be considered as a viable option for young ECC patients with strong fertility preservation desire, resulting in better pregnancy and live birth outcomes.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier PROSPERO (CRD42023423432).

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Section: Search Resultsmentioning

confidence: 99%

Section: Live Birth Rate and Miscarriage Ratementioning

confidence: 99%

Section: Fertility and Oncologic Outcomes 341 Pregnancy Ratesmentioning

confidence: 99%

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Oncological and reproductive outcomes of conization combined with pelvic node evaluation in patients with early-stage cervical cancer: a systematic review and meta-analysis

Wang,

Chen,

Wang

et al. 2023

Front. Oncol.

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“…Absence of residual disease in the cervix was of great importance. There were some clinical trials recently which showed that cervical conization with lymph node evaluation may be a feasible conservation management in low-risk cervical cancer [ 29 , 30 ]. Negative surgical margin (> 3 mm) after conization could be oncologic safe even in fertility-sparing patients with stage IB1 (≤ 2 cm).…”

Section: Discussionmentioning

confidence: 99%

Association of preoperative conization with recurrences after laparoscopic radical hysterectomy for FIGO 2018 stage IB1 cervical cancer

Ding

Zhang

et al. 2022

Arch Gynecol Obstet

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Objective To evaluate association of preoperative conization with recurrences after laparoscopic radical hysterectomy (LRH) for FIGO 2018 stage IB1 cervical cancer. Methods This is a retrospective single-center study. Patients who underwent LRH for cervical cancer with squamous, adenosquamous and adenocarcinoma subtype from January 2014 to December 2018 were reviewed. All patients were restaged according to the 2018 FIGO staging system. Those who were in FIGO 2018 stage IB1 met the inclusion criteria. General characteristics and oncologic outcomes including recurrence-free survival (RFS) were analyzed. Results A total of 1273 patients were included in the analysis. 616 (48.4%) patients underwent preoperative biopsy, and 657 (51.6%) patients underwent conization. Residual disease was observed in 822 (64.6%) patients. During a median follow-up of 50.30 months, 30 (2.4%) patients experienced recurrence. The univariate analysis showed that patients who had larger tumor diameter, the presence of residual tumor at final pathology, and underwent adjuvant treatment had a significant higher risk of recurrence (P < 0.01). Conversely, patients who underwent conization were significantly less likely to experience recurrence (P = 0.001). In the multivariate analysis, the independent risk factor associated with an increased risk of recurrence was resident macroscopic tumor (HR: 38.4, 95% CI 4.20–351.64, P = 0.001). On the contrary, preoperative conization was associated with a significantly lower risk of recurrence (HR: 0.26; 95% CI 0.10–0.63, P = 0.003). The Kaplan–Meier curves showed patients who underwent conization had improved survival over those who underwent biopsy (5 year RFS: 98.6 vs 95.1%, P = 0.001). The 5 year RFS of patients with residual tumor was significantly different (R0: 99.2%, R1: 97.4%, R2: 93.6%, P < 0.001), especially the patients with residual macroscopic tumor after conization (R0: 99.5%, R1: 99.0%, R2:92.4%, P = 0.006). Conclusion Preoperative conization and the absence of residual tumor at the time of surgery might play a protective role in patients with FIGO 2018 IB1 cervical cancer following LRH, which support the theory of the influence of intraoperative tumor spread during radical hysterectomy. Further prospective evidence is needed.

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“…Cervical cancer is a malignant tumor that occurs in the cervix site with nonspecific symptoms at the early stage, and with the development of the disease, patients can present vaginal bleeding, vaginal discharge, and other symptoms. In the late stage, different secondary symptoms will show depending on the extent of cancer foci involvement, such as ureteral obstruction and uremia, and even systemic failure phenomenon such as cachexia in severe cases [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Significance of Magnetic Resonance Imaging Combining with Detection of Serum HE4, TSGF, and CD105 Levels in Diagnosis and Treatment of Moderate to Advanced Cervical Cancer

Meng

Qiu²,

Wang

2022

Contrast Media & Molecular Imaging

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Objective. To explore the significance of magnetic resonance imaging (MRI) combining with detection of serum HE4, TSGF, and CD105 levels in diagnosis and treatment of moderate to advanced cervical cancer. Methods. By means of retrospective study, 50 patients diagnosed with moderate to advanced cervical cancer by cervix biopsy pathology examination in our hospital from October 2018 to October 2019 were selected as the study group, and another 50 healthy individuals who did not have cervical cancer after routine gynecological examination and conventional ultrasound examination in the same period were selected as the control group. At the time of enrollment and 3 months after treatment, all study subjects received MRI examination and serological examination, and their HE4 and TSGF levels were measured by the enzyme-linked immunosorbent assay (ELISA) and chromatography method, respectively, and additionally, the immunohistochemistry SP method was adopted for patients in the study group to measure the microvessel density (MVD) marked by CD105. The relationship between MRI staging and FIGO staging was assessed, the efficacy of combining MRI with detection of serum HE4, TSGF, and CD105 levels in diagnosing moderate to advanced cervical cancer was calculated by plotting the ROC curve, and the imaging changes and serological changes of tumor tissue before and after treatment were analyzed. Results. There were 3 of 4 patients in stage IIa and 14 of 15 patients in stage IIIb presenting MRI findings compatible with clinical examinations; 26 patients in stage IIb and 5 patients in stage IVb presenting MRI findings totally compatible with clinical examination. Before treatment, MRI finding of cervical lesion was irregular soft tissue mass, T1WI appeared isointensity or hyperintensity, and obvious lesion enhancement could be seen by enhanced scan. T2WI appeared mixed signal intensity or hyperintensity, with necrotic tissue and fat suppression being hyperintensity. After treatment, lesions shrunk, originally abnormal signals in 5 patients disappeared, and T1WI and T2WI signals in 45 patients presented no difference compared to before treatment. After T1WI enhancement, mild enhancement could be seen in 41 cases and no enhancement in 4 cases. The CD105-MVD of the study group was (68.98 ± 5.23); before and after treatment, the differences in HE4 and TSGF levels between the study group and the control group were significant ( P < 0.001 ). The sensitivity, specificity, and accuracy rate of diagnosis of MRI diagnosis were respectively 82.0% (41/50), 90.0% (45/50), and 86.0% (86/100), and for the diagnosis combining with serum HE4, TSGF, and CD105 levels, they were 96.0% (48/50), 96.0% (48/50), and 96.0% (96/100), respectively, and AUC (95% CI) = 0.960 (0.908–1.000). Conclusion. MRI staging is objective and accurate and has higher sensitivity when combined with serum HE4, TSGF, and CD105 levels in diagnosing moderate to advanced cervical cancer. All MRI, HE4, and TSGF can reflect the treatment effect of patients and are of great importance to efficacy assessment.

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Conization and lymph node evaluation in low-risk cervical cancer. Is it time to avoid radical surgery? Retrospective series and literature review

Cited by 8 publications

References 42 publications

Oncological and reproductive outcomes of conization combined with pelvic node evaluation in patients with early-stage cervical cancer: a systematic review and meta-analysis

Oncological and reproductive outcomes of conization combined with pelvic node evaluation in patients with early-stage cervical cancer: a systematic review and meta-analysis

Association of preoperative conization with recurrences after laparoscopic radical hysterectomy for FIGO 2018 stage IB1 cervical cancer

Significance of Magnetic Resonance Imaging Combining with Detection of Serum HE4, TSGF, and CD105 Levels in Diagnosis and Treatment of Moderate to Advanced Cervical Cancer

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