Radical hysterectomy in early cervical cancer in Europe: characteristics, outcomes and evaluation of ESGO quality indicators

Boria, Félix; Chiva, Luis; Zanagnolo, Vanna; Querleu, Denis; Martín‐Calvo, Nerea; Căpîlna, Mihai Emil; Fagotti, Anna; Kucukmetin, Ali; Mom, Constantijne H.; Chakalova, G; Aliyev, Shamistan; Malzoni, Mario; Narducci, Fabrice; Arencibia, Octavio; Raspagliesi, Francesco; Toptaş, Tayfun; Cibula, David; Kaidarova, Dilyara; Meydanlı, Mehmet Mutlu; Tavares, Márcio; Golub, Dmytro; Perrone, Anna Myriam; Póka, Ròbert; Tsolakidis, Dimitrios; Vujić, Goran; Jędryka, Marcin; Zusterzeel, Petra L.M.; Beltman, Jogchum Jan; Goffin, Frédéric; Haidopoulos, Dimitrios; Haller, Herman; Jach, Robert; Yezhova, Iryna; Berlev, Igor; Bernardino, Margarida; Bharathan, Rasiah; Lanner, Maximilian; Mäenpää, Minna; Sukhin, Vladyslav; Féron, Jean Guillaume; Fruscio, Robert; Kukk, Kersti; Ponce, Jordi; Alonso-Espías, María; Mínguez, J.; Vázquez-Vicente, Daniel; Manzour, Nabil; Jurado, M.; Castellanos, Teresa; Chacón, Enrique; Alcázar, Juan Luis

doi:10.1136/ijgc-2021-002587

Cited by 9 publications

(9 citation statements)

References 24 publications

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“…The inclusion criteria were 15 : age ≥18 years; histologic type: squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma; and pelvic magnetic resonance image (MRI) confirming a tumor diameter ≤4 cm with no parametrial invasion and a preoperative computerised tomography (CT) scan, MRI, or positron emission tomography-computed tomography (PET-CT) demonstrating no extracervical metastatic disease. The operative report had to describe type B-C radical hysterectomy with bilateral pelvic lymphadenectomy by either minimally invasive surgery (laparoscopic or robotic) or open surgery, including at least 10 pelvic nodes.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

SUCCOR cone study: conization before radical hysterectomy

Chacón

Manzour

Zanagnolo

et al. 2022

Int J Gynecol Cancer

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ObjectiveTo evaluate disease-free survival of cervical conization prior to radical hysterectomy in patients with stage IB1 cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009).MethodsA multicenter retrospective observational cohort study was conducted including patients from the Surgery in Cervical Cancer Comparing Different Surgical Aproaches in Stage IB1 Cervical Cancer (SUCCOR) database with FIGO 2009 IB1 cervical carcinoma treated with radical hysterectomy between January 1, 2013, and December 31, 2014. We used propensity score matching to minimize the potential allocation biases arising from the retrospective design. Patients who underwent conization but were similar for other measured characteristics were matched 1:1 to patients from the non-cone group using a caliper width ≤0.2 standard deviations of the logit odds of the estimated propensity score.ResultsWe obtained a weighted cohort of 374 patients (187 patients with prior conization and 187 non-conization patients). We found a 65% reduction in the risk of relapse for patients who had cervical conization prior to radical hysterectomy (hazard ratio (HR) 0.35, 95% confidence interval (CI) 0.16 to 0.75, p=0.007) and a 75% reduction in the risk of death for the same sample (HR 0.25, 95% CI 0.07 to 0.90, p=0.033). In addition, patients who underwent minimally invasive surgery without prior conization had a 5.63 times higher chance of relapse compared with those who had an open approach and previous conization (HR 5.63, 95% CI 1.64 to 19.3, p=0.006). Patients who underwent minimally invasive surgery with prior conization and those who underwent open surgery without prior conization showed no differences in relapse rates compared with those who underwent open surgery with prior cone biopsy (reference) (HR 1.94, 95% CI 0.49 to 7.76, p=0.349 and HR 2.94, 95% CI 0.80 to 10.86, p=0.106 respectively).ConclusionsIn this retrospective study, patients undergoing cervical conization before radical hysterectomy had a significantly lower risk of relapse and death.

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Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

SUCCOR cone study: conization before radical hysterectomy

Chacón

Manzour

Zanagnolo

et al. 2022

Int J Gynecol Cancer

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“…The estimated number of new cases of cervical cancer in Europe in 2020 was 58 169, with 25 989 deaths 1. Surgery represents the main treatment in early stages (International Federation of Gynecology and Obstetrics (FIGO) 2018 IA–IB2) and the 5-year disease-free survival rate in the largest European cohorts ranges from 87.7% to 88.3% 2 3. However, several differences in survival can be found across Europe.…”

Section: Introductionmentioning

confidence: 99%

SUCCOR quality: validation of ESGO quality indicators for surgical treatment of cervical cancer

Boria

Chiva²,

Chacón³

et al. 2022

Int J Gynecol Cancer

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ObjectiveTo evaluate whether compliance with European Society of Gynaecological Oncology (ESGO) surgery quality indicators impacts disease-free survival in patients undergoing radical hysterectomy for cervical cancer.MethodsIn this retrospective cohort study, 15 ESGO quality indicators were assessed in the SUCCOR database (patients who underwent radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage 2009 IB1, FIGO 2018 IB1, and IB2 cervical cancer between January 2013 and December 2014), and the final score ranged between 0 and 16 points. Centers with more than 13 points were classified as high-quality indicator compliance centers. We constructed a weighted cohort using inverse probability weighting to adjust for the variables. We compared disease-free survival and overall survival using Cox proportional hazards regression analysis in the weighted cohort.ResultsA total of 838 patients were included in the study. The mean number of quality indicators compliance in this cohort was 13.6 (SD 1.45). A total of 479 (57.2%) patients were operated on at high compliance centers and 359 (42.8%) patients at low compliance centers. High compliance centers performed more open surgeries (58.4% vs 36.7%, p<0.01). Women who were operated on at centers with high compliance with quality indicators had a significantly lower risk of relapse (HR=0.39; 95% CI 0.25 to 0.61; p<0.001). The association was reduced, but remained significant, after further adjustment for conization, surgical approach, and use of manipulator surgery (HR=0.48; 95% CI 0.30 to 0.75; p=0.001) and adjustment for adjuvant therapy (HR=0.47; 95% CI 0.30 to 0.74; p=0.001). Risk of death from disease was significantly lower in women operated on at centers with high adherence to quality indicators (HR=0.43; 95% CI 0.19 to 0.97; p=0.041). However, the association was not significant after adjustment for conization, surgical approach, use of manipulator surgery, and adjuvant therapy.ConclusionsPatients with early cervical cancer who underwent radical hysterectomy in centers with high compliance with ESGO quality indicators had a lower risk of recurrence and death.

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“…Furthermore, secondary endpoint analyses demonstrated that MIS showed similar perioperative outcomes with open approach, and did not improve postoperative quality of life [ 19 , 20 ]. Thus, updated guidelines including the NCCN and ESGO support that laparotomy should be preferred procedure for radical hysterectomy [ 4 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

The Role of Conization before Radical Hysterectomy in Cervical Cancer including High Risk Factors of Recurrence: Propensity Score Matching

Chang

Min

Song

et al. 2022

Cancers

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We primarily aimed to investigate the therapeutic role of conization prior to radical hysterectomy for cervical cancer. Secondarily, we aimed to characterize a subgroup of patients who could potentially benefit from preoperative conization. Patients who underwent radical hysterectomy for FIGO 2009 stage IB1 to IIB cervical cancer from 1995 to 2020 were eligible. The patients were divided into two groups: those with and without preoperative conization. To adjust for the baseline characteristics of the two groups, 1:2 case–control propensity score matching was conducted. Survival analysis was performed between the two groups. Subgroup analysis was performed to identify the effect of conization based on clinical and pathological factors. Patients who underwent preoperative conization showed better 5-year overall survival than those who did not (95.9% vs. 93.0%, p = 0.029); however, no difference was observed in progression-free survival (88.9% vs. 85.9%, p = 0.155). In multivariate Cox analysis, conization showed a 55% reduction in recurrence (hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.41–1.01, p = 0.056) and 41% reduction in death (HR 0.59, 95% CI 0.34–1.02, p = 0.059), but with marginal statistical significance. In subgroup analysis, minimally invasive surgery (MIS), negative pelvic lymph node, and tumor size < 4 cm showed improved survival from conization. Conization before radical hysterectomy may be associated with improved survival in patients with early-stage cervical cancer. This information could serve as a basis for a more tailored patient selection for MIS for cervical cancer.

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Radical hysterectomy in early cervical cancer in Europe: characteristics, outcomes and evaluation of ESGO quality indicators

Cited by 9 publications

References 24 publications

SUCCOR cone study: conization before radical hysterectomy

SUCCOR cone study: conization before radical hysterectomy

SUCCOR quality: validation of ESGO quality indicators for surgical treatment of cervical cancer

The Role of Conization before Radical Hysterectomy in Cervical Cancer including High Risk Factors of Recurrence: Propensity Score Matching

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