Does a pre-operative conization improve disease-free survival in early-stage cervical cancer?

Benoit, Louise; Koual, Meriem; Nguyen-Xuan, Huyên-Thu; Balaya, Vincent; Nos, Claude; Montero-Macías, Rosa; Bats, Anne‐Sophie

doi:10.1007/s00404-020-05798-7

Cited by 10 publications

(8 citation statements)

References 23 publications

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“…Recently, the protective role of preoperative conization has been highlighted in several studies. These studies collectively agreed upon the improved prognosis in patients with preoperative conization [ 12 , 13 , 14 , 15 , 16 ].…”

Section: Introductionsupporting

confidence: 61%

“…Casarin et al [ 12 ] reported that conization before minimally invasive radical hysterectomy in FIGO 2009 stage IA1–IB1 cervical cancer was associated with a lower recurrence rate (1.1% vs. 16.1%, p < 0.001). Benoit et al [ 13 ] also drew a similar conclusion showing superior DFS with preoperative conization in patients with FIGO 2018 stage IA1–IB2 cervical cancer, although the result may not be statistically significant (HR 0.19, 95% CI 0.02–1.63, p = 0.070). Shortly after, three recent studies investigated the role of conization in early cervical cancer using the propensity score matching method to equalize the characteristics of patients between groups [ 14 , 15 , 16 ].…”

Section: Discussionmentioning

confidence: 85%

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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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Section: Introductionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 85%

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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“…It would still have been possible to modify the therapy after conization depending on the stromal infiltration in the sense of a “patient-tailored surgical treatment”. In addition, conization can improve the prognosis of common cervical carcinoma [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Villoglandular adenocarcinoma of the uterine cervix: a systematic review and meta-analysis

Dietl

Beckmann

Aumann

2021

Arch Gynecol Obstet

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Purpose Villoglandular adenocarcinoma (VGA) of the uterine cervix has been classified as a rare subtype of cervical adenocarcinoma with good prognosis. A conservative surgical approach is considered feasible. The main risk factor is the presence of other histologic types of cancer. In this largest systematic review to date, we assess oncological outcomes associated with conservative therapy compared to those associated with invasive management in the treatment of stage Ia and Ib1 VGA. Methods Case series and case reports identified by searching the PubMed database were eligible for inclusion in this review (stage Ia–Ib1). Results A total of 271 patients were included in our literature review. 54 (20%) patients were treated by “conservative management” (conization, simple hysterectomy, and trachelectomy) and 217 (80%) by “invasive management” (radical hysterectomy ± radiation, hysterectomy, and radiation). Recurrences of disease (RODs) were found in the conservative group in two (4%) cases and in the invasive group in nine (4%) cases. There was no significant difference in disease-free survival (DFS) according to conservative or invasive treatment (p = 0.75). The histology of VGA may be complex with underlying usual adenocarcinoma (UAC) combined with VGA. Conclusion The excellent prognosis of pure VGA and the young age of the patients may justify the management of this tumor using a less radical procedure. The histological diagnosis of VGA is a challenge, and pretreatment should not be based solely on a simple punch biopsy but rather a conization with wide tumor-free margins.

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“…Given that patients with intermediate or high risk criteria would be eligible for adjuvant therapy, LVSI status in conization specimens may influence the type of primary treatment [ 44 ]. Furthermore, several studies demonstrated that preoperative conization was associated with better oncologic outcomes [ 45 , 46 , 47 ]. This lower risk of recurrence associated with prior conization may be explained by decreased risk of tumor dissemination, especially in cases of negative margin status.…”

Section: Discussionmentioning

confidence: 99%

Can Conization Specimens Predict Sentinel Lymph Node Status in Early-Stage Cervical Cancer? A SENTICOL Group Study

Balaya

Guani

Mereaux

et al. 2021

Cancers

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Background: The prognosis of patients with cervical cancer is significantly worsened in case of lymph node involvement. The goal of this study was to determine whether pathologic features in conization specimens can predict the sentinel lymph node (SLN) status in early-stage cervical cancer. Methods: An ancillary analysis of two prospective multicentric database on SLN biopsy for cervical cancer (SENTICOL I and II) was carried out. Patients with IA to IB2 2018 FIGO stage, who underwent preoperative conization before SLN biopsy were included. Results: Between January 2005 and July 2012, 161 patients from 25 French centers fulfilled the inclusion criteria. Macrometastases, micrometastases and Isolated tumor cells (ITCs) were found in 4 (2.5%), 6 (3.7%) and 5 (3.1%) patients respectively. Compared to negative SLN patients, patients with micrometastatic and macrometastatic SLN were more likely to have lymphovascular space invasion (LVSI) (60% vs. 29.5%, p = 0.04) and deep stromal invasion (DSI) ≥ 10 mm (50% vs. 17.8%, p = 0.04). Among the 93 patients with DSI < 10 mm and absence of LVSI on conization specimens, three patients (3.2%) had ITCs and only one (1.1%) had micrometastases. Conclusions: Patients with DSI < 10 mm and no LVSI in conization specimens had lower risk of micro- and macrometastatic SLN. In this subpopulation, full node dissection may be questionable in case of SLN unilateral detection.

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Does a pre-operative conization improve disease-free survival in early-stage cervical cancer?

Cited by 10 publications

References 23 publications

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

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

Villoglandular adenocarcinoma of the uterine cervix: a systematic review and meta-analysis

Can Conization Specimens Predict Sentinel Lymph Node Status in Early-Stage Cervical Cancer? A SENTICOL Group Study

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