ArticleAmerican journal of obstetrics and gynecology2024
Fertility-sparing surgery vs standard surgery for early-stage cervical cancer: difference in 5-year life expectancy by tumor size.
Article in American journal of obstetrics and gynecology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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6 citing papers in PubMed, 12 citations in OpenAlex.
- One more opportunity in early-stage cervical cancer: the role of photodynamic therapy in managing positive surgical margins.Journal of gynecologic oncology · 2026Article
- High-Risk Clinical Characteristics and Risk Model for Unexpected Cervical Cancer Diagnosed After Surgery in Patients with LSIL/HSIL Biopsy.International journal of women's health · 2026Article
- Validation of data quality in the Swedish quality register of gynecologic cancer for cervical cancer and vulvar cancer-a Swedish gynecologic cancer group (Swe-GCG) study.Acta obstetricia et gynecologica Scandinavica · 2025Article
- A long-term retrospective analysis of oncologic and fertility outcomes in cervical cancer patients undergoing radical trachelectomy.Frontiers in oncology · 2025Article
- Histologically confirmed high-grade cervical intraepithelial neoplasia successfully treated with topical Paiteling: a two-case report.Frontiers in medicine · 2025Article
- Meta-analysis of risk factors for recurrence in cervical cancer patients following fertility-sparing treatment.Frontiers in surgery · 2025Article
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundCervical cancer incidence among premenopausal women is rising, and fertility-sparing surgery serves as an important option for this young population. There is a lack of evidence on what tumor size cutoff should be used to define candidacy for fertility-sparing surgery.
objectiveWe sought to describe how the association between fertility-sparing surgery (compared with standard surgery) and life expectancy varies by tumor size among patients with cervical cancers measuring ≤4 cm in largest diameter. Our secondary objective was to quantify the probability of undergoing adjuvant radiotherapy among patients who underwent fertility-sparing surgery as a function of tumor size. STUDY
designWe identified patients in the National Cancer Database aged ≤45 years, diagnosed with stage I cervical cancer with tumors ≤4 cm between 2006 and 2018, who received no preoperative radiation or chemotherapy, and who underwent either fertility-sparing surgery (cone or trachelectomy, either simple or radical) or standard surgery (simple or radical hysterectomy) as their primary treatment. Propensity-score matching was performed to compare patients who underwent fertility-sparing surgery with those who underwent standard surgery. A flexible parametric model was employed to quantify the difference in life expectancy within 5 years of diagnosis (restricted mean survival time) based on tumor size among patients who underwent fertility-sparing and those who underwent standard surgery. In addition, among those who underwent fertility-sparing surgery, a logistic regression model was used to explore the relationship between tumor size and the probability of receiving adjuvant radiation.
resultsA total of 11,946 patients met the inclusion criteria of whom 904 (7.6%) underwent fertility-sparing surgery. After propensity-score matching, 897 patients who underwent fertility-sparing surgery were matched 1:1 with those who underwent standard surgery. Although the 5-year life expectancy was similar among patients who had fertility sparing surgery and those who had standard surgery regardless of tumor sizes, the estimates of life-expectancy differences associated with fertility-sparing surgery were more precise among patients with smaller tumors (1-cm tumor: restricted mean survival time difference, -0.10 months; 95% confidence interval, -0.67 to 0.47) than among those with larger tumors (4-cm tumor: restricted mean survival time difference, -0.11 months; 95% confidence interval, -3.79 to 3.57). The probability of receiving adjuvant radiation increased with tumor size, ranging from 5.6% (95% confidence interval, 3.9-7.9) for a 1-cm tumor to 37% (95% confidence interval, 24.3-51.8) for a 4-cm tumor.
conclusionWithin 5 years of diagnosis, young patients with stage I cancers measuring ≤4 cm had similar survival outcomes after either fertility-sparing surgery or standard surgery. However, because few patients with tumors >2 cm underwent fertility-sparing surgery, a clinically important survival difference could not be excluded in this population.
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