Discussion on the Treatment Strategy for Stage ⅡA1 Cervical Cancer (FIGO 2018)

Abstract

ObjectiveThis study aimed to explore the best treatment strategy for International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIA1 cervical cancer patients by comparing the survival outcomes of two treatment methods: abdominal radical hysterectomy (ARH) with standard postoperative therapy and radio-chemotherapy (R-CT).MethodsPatients with FIGO2018 stage IIA1 cervical cancer who underwent ARH or received R-CT were screened from the clinical diagnosis and treatment for cervical cancer in China (Four C) database. The recurrence cases between the two groups were analyzed. The 5-year overall survival (OS) and disease-free survival (DFS) of patients diagnosed with stage IIA1 cervical cancer in 47 hospitals in mainland China between 2004 and 2018 were compared by using propensity score matching (PSM).ResultsA total of 724 patients met the inclusion criteria. In the total study population, The R-CT group had higher recurrence (22.8% for the R-CT group and 11.2% for the ARH group, P<0.001) rates compared to the ARH group.The 5-year OS and DFS of the ARH group (n=658) were significantly higher than those of the R-CT group (n=66) (OS: 85.9% vs. 71.2%, P=0.009; DFS: 79.2%vs. 70.5%, P=0.027). R-CT was associated with worse 5-year OS (HR=3.19, 95% CI: 1.592-6.956, P=0.001) and DFS (HR=2.089, 95% CI: 1.194-3.656, P=0.01). After 1:2 PSM, the 5-year OS and DFS of the ARH group (n=126) were significantly higher than those of the R-CT group (n=64) (OS:88.9% vs. 70.1%, P=0.04; DFS:82.8% vs. 69.8%, P=0.019). R-CT was still associated with worse 5-year OS (HR=2.391, 95% CI: 1.051-5.633, P=0.046) and DFS (HR=2.6, 95% CI: 1.25-5.409, P=0.011).ConclusionOur study demonstrated that for stage FIGO2018 stage IIA1 cervical cancer patients, ARH offers better oncological outcomes than R-CT.

Laparoscopic Versus Abdominal Radical Hysterectomy for Cervical Cancer

“…41,42 Because of the magnifying effect of laparoscopic equipment, it is easier and clearer for the operator to identify important tissue structures such as blood vessels and nerves and the local anatomical relationship between them during surgical operations. [43][44][45] When the laparoscopic eyepiece is close to the observation target, the surgical details can be observed for better and finer operation, and the bleedingprone tissue can be effectively and preventively avoided. When the laparoscopic eyepiece is retreated, the surgical field of view can be expanded, and the operator's awareness of the operation can be improved.…”

“…When laparoscopic ultrasonic scalpel is used for tissue separation during surgery, it can not only cut tissue but also stop bleeding in a timely and effective manner, reducing unnecessary bleeding 41,42. Because of the magnifying effect of laparoscopic equipment, it is easier and clearer for the operator to identify important tissue structures such as blood vessels and nerves and the local anatomical relationship between them during surgical operations 43–45. When the laparoscopic eyepiece is close to the observation target, the surgical details can be observed for better and finer operation, and the bleeding-prone tissue can be effectively and preventively avoided.…”

Current Therapeutic Approaches in Cervical Cancer Based on the Stage of the Disease: Is There Room for Improvement?

“…Regarding stage IIA1, an important aspect is highlighted by the study published by Chen et al of 724 patients in which they compared overall and disease-free survival at 5 years in two groups: a group in which radical abdominal hysterectomy was performed and a group in which they performed only radiochemotherapy, the result being clearly in favor of hysterectomy [ 50 ]. The 5-year survival prognosis is 70.3% [ 34 ].…”

“…The 5-year survival prognosis is 70.3% [ 34 ]. In extremely well-selected cases, in young patients, and if the preservation of fertility is attempted, it can be opted for trachelectomy [ 50 ].…”

“…In stage IIA2, which is a locally advanced stage and the tumor exceeds 4 cm—the so-called “bulky” tumor, the standard of treatment is a combination of radio- and chemotherapy, and the survival seems comparable to other more radical methods of treatment [ 50 , 51 ]. However, according to NCCN guidelines, some experts express the opinion that at this stage, a pelvic lymph node dissection can be performed, and if there is no lymph node invasion, then a radical hysterectomy can be executed.…”