The following is a summary of “Analysis of risk factors for recurrence in cervical cancer patients after fertility-sparing treatment: The FERTIlity Sparing Surgery retrospective multicenter study,” published in the APRIL 2023 issue of Obstetrics and Gynecology by Slama, et al.

Fertility-sparing treatment for cervical cancer should follow similar protocols as those for patients who do not have future reproductive plans. Nonradical procedures, such as conization or simple trachelectomy, have gained popularity due to their association with improved pregnancy outcomes. However, previous studies on the safety of these approaches have included small patient populations and employed heterogeneous treatment strategies. For a study, researchers sought to gather data from multiple institutions to evaluate the oncological outcomes of fertility-sparing treatment in cervical cancer patients. They also aimed to identify prognostic risk factors, including the impact of the radicality of individual cervical procedures.

The retrospective observational study included patients between the ages of 18 and 40 with International Federation of Gynecology and Obstetrics 2018 stage IA1 with positive lymphovascular space invasion or ≥IA2 cervical cancer. All patients who underwent any form of fertility-sparing procedure were eligible for inclusion, regardless of histotype, tumor grade, or prior neoadjuvant chemotherapy. The study analyzed associations between disease- and treatment-related factors and the risk of recurrence.

A total of 733 patients from 44 institutions across 13 countries were included in the study. Nearly half of the patients had stage IB1 cervical cancer (49%), and two-thirds were nulliparous (66%). After a median follow-up of 72 months, 51 patients (7%) experienced recurrence, and 19 (2.6%) died due to the disease. The cervix (53%) and pelvic nodes (22%) were the most common sites of recurrence. Patients with tumors larger than 2 cm had a threefold higher risk of recurrence compared to those with smaller tumors, regardless of treatment radicality (19.4% vs. 5.7%; hazard ratio 2.982; 95% confidence interval 1.383–6.431; P = 0.005). However, the risk of recurrence did not differ between radical trachelectomy and nonradical (conization and simple trachelectomy) procedures in patients with tumors ≤2 cm, regardless of tumor size subcategory (<1 or 1–2 cm) or lymphovascular space invasion.

In the large multicenter retrospective study, nonradical fertility-sparing cervical procedures were not associated with an increased risk of recurrence compared to radical procedures in patients with tumors ≤2 cm. However, patients with tumors >2 cm had a significantly higher risk of recurrence regardless of the treatment radicality.

Source: ajog.org/article/S0002-9378(22)02188-3/fulltext