The following is a summary of “Survival associated with extent of radical hysterectomy in early-stage cervical cancer: a subanalysis of the Surveillance in Cervical CANcer (SCCAN) collaborative study,” published in the OCTOBER 2023 issue of Obstetrics and Gynecology by Bizzarri, et al.
Current international guidelines advocate tailoring the radicality of hysterectomy based on preoperative tumor characteristics in early-stage cervical cancer patients. For a study, researchers sought to evaluate the impact of increased radicality on 5-year disease-free survival in early-stage cervical cancer patients undergoing radical hysterectomy. Secondary objectives included assessing 5-year overall survival and recurrence patterns.
Conducted as an international, multicenter, retrospective investigation within the Surveillance in Cervical CANcer (SCCAN) collaborative cohort, the study focused on patients diagnosed with International Federation of Gynecology and Obstetrics 2009 stage IB1 and IIA1. The inclusion criteria comprised those who underwent open type B/C1/C2 radical hysterectomy (Querleu-Morrow classification) between January 2007 and December 2016, without receiving neoadjuvant chemotherapy and exhibiting negative lymph nodes and free surgical margins in final histology. Descriptive statistics, survival analyses, and propensity score match analysis were utilized, with patient stratification based on pathologic tumor diameter.
In the study involving 1,257 patients with early-stage cervical cancer, 70.2% underwent nerve-sparing radical hysterectomy, while 29.8% opted for non–nerve-sparing radical hysterectomy. Noteworthy baseline disparities were observed, with non–nerve-sparing procedures more frequently chosen for tumors >2 cm or with vaginal involvement P<.0001. Adjuvant treatment was used in 27.3% vs. 28.6% of patients undergoing nerve-sparing vs. non-nerve-sparing radical hysterectomy (P=.63). The five-year disease-free survival rate in patients following nerve-sparing vs non-nerve-sparing radical hysterectomy was 90.1% (95% CI, 87.9-92.2) vs 93.8% (91.1-96.5), respectively (P=.047). The study’s multivariable analysis across the entire cohort identified that non–nerve-sparing radical hysterectomy was independently associated with improved disease-free survival, revealing a hazard ratio of 0.50 (95% CI, 0.31–0.81; P=.004). However, there was no significant difference in five-year overall survival between patients undergoing nerve-sparing (95.7%) and non–nerve-sparing radical hysterectomy (96.5%) (P=.78). Subgroup analysis based on tumor diameter revealed comparable five-year disease-free survival rates in patients with tumors ≤20 mm (94.7% nerve-sparing vs. 96.2% non–nerve-sparing, P=.22). In contrast, for tumors between 21 and 40 mm, non–nerve-sparing radical hysterectomy was associated with significantly better five-year disease-free survival (90.3%) compared to nerve-sparing radical hysterectomy (83.1%) (P=.016), and this difference persisted after propensity score match analysis. Importantly, the pattern of recurrence in the propensity-matched population did not exhibit any significant difference (P=.70). These findings underscore the nuanced impact of surgical radicality on disease-free survival outcomes in early-stage cervical cancer, considering tumor size and surgical approach.
In conclusion, the study discerned that for tumors with a diameter of 20 mm or less, no survival disparity was identified with a more radical hysterectomy approach; however, for tumors ranging between 21 and 40 mm, a more radical hysterectomy correlated with enhanced 5-year disease-free survival. Importantly, there was no discernible difference in the recurrence patterns based on the extent of surgical radicality. Notably, after propensity score match analysis, non–nerve-sparing radical hysterectomy exhibited superior 5-year disease-free survival compared to nerve-sparing radical hysterectomy. The findings contributed valuable insights into tailoring surgical approaches for early-stage cervical cancer patients, emphasizing the nuanced impact of tumor size on the efficacy of radical hysterectomy.