Comparison between laparoscopic and abdominal radical hysterectomy for cervical adenosquamous carcinoma at stage IA2 to IIA2: A multicenter retrospective study

Abstract

Objective We aimed to compare the 5‐year oncological outcomes of laparoscopic/abdominal radical hysterectomy (LRH/ARH) in patients with cervical adenosquamous carcinoma at stage IA2 to IIA2 based on the 2009 or 2018 International Federation of Gynecology and Obstetrics (FIGO) staging criteria. Methods Based on the clinical diagnosis and treatment of cervical cancer in China (Four C) database, Cox risk regression models were applied to analyze tumor prognosis treated with ARH/LRH in FIGO 2009 and 2018 IA2‐IIA2 patients and stratified findings according to tumor diameter (≤4 and >4 cm subgroups). And to avoid bias, propensity score matching (PSM) was also used for the cohort study. Results Based on FIGO 2009 staging criteria (n = 474), there was no significant difference between the ARH and LRH groups in 5‐year disease‐free survival (DFS) or overall survival (OS). Lymph node metastasis was a risk factor for 5‐year DFS in this stage. After PSM, lymphovascular space invasion (LVSI) was an independent risk factor for 5‐year OS in the tumors ≤4 cm subgroup. Based on FIGO2018 staging criteria (n = 322), cervical interstitial infiltration depth was an independent risk factor for 5‐year OS in the total population and the tumor diameter ≤4 cm subgroup. Conclusions Laparoscopic surgery was not a risk factor affecting the oncologic prognosis of adenosquamous carcinoma of the cervix based on either FIGO 2009 or 2018 staging of stage IA2‐IIA2. In addition, LRH may be considered for patients with early‐stage cervical adenosquamous carcinoma.