Predictors of recurrence following laparoscopic radical hysterectomy for early-stage cervical cancer: A multi-institutional study

J. Casarin, A. Buda, G. Bogani, F. Fanfani, A. Papadia, M. Ceccaroni, M. Malzoni, A. Pellegrino, F. Ferrari, S. Greggi, S. Uccella, C. Pinelli, A. Cromi, A. Ditto, G. Di Martino, L. Pedone Anchora, F. Falcone, F. Bonfiglio, F. Odicino, M. MuellerG. Scambia, F. Raspagliesi, F. Landoni, F. Ghezzi

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To assess predictors of recurrence following laparoscopic radical hysterectomy (LRH) for apparent early stage cervical cancer (CC). Methods: This is a retrospective multi-institutional study reviewing data of consecutive patients who underwent LRH for FIGO 2009 stage IA1 (with lymphovascular space invasion (LVSI)), IA2 and IB1(≤4 cm) CC, between January 2006 and December 2017. The following histotypes were included: squamous, adenosquamous, and adenocarcinoma. Multivariable models were used to estimate adjusted odds ratio (OR) and corresponding 95% CI. Factors influencing disease-free survival (DFS) and disease-specific survival (DSS) were also explored. Results: 428 patients were included in the analysis. With a median follow-up of 56 months (1–162) 54 patients recurred (12.6%). At multivariable analysis, tumor size (OR:1.04, 95%CI:1.01–1.09, p = .02), and presence of cervical residual tumor at final pathology (OR: 5.29, 95%CI:1.34–20.76, p = .02) were found as predictors of recurrence; conversely preoperative conization reduced the risk (OR:0.32, 95%CI:0.11–0.90, p = .03). These predictors remained significant also in the IB1 subgroup: tumor size: OR:1.05, 95%CI:1.01–1.09, p = .01; residual tumor at final pathology: OR: 6.26, 95%CI:1.58–24.83, p = .01; preoperative conization: OR:0.33, 95%CI:0.12–0.95, p = .04. Preoperative conization (HR: 0.29, 95%CI: 0.13–0.91; p = .03) and the presence of residual tumor on the cervix at the time of surgery (HR: 8.89; 95%CI: 1.39–17.23; p = .01) independently correlated with DFS. No independent factors were associated with DSS. Conclusions: In women with early stage CC the presence of high-volume disease at time of surgery represent an independent predictor of recurrence after LRH. Conversely, preoperative conization and the absence of residual disease at the time of surgery might play a protective role.

Original languageEnglish
JournalGynecologic Oncology
DOIs
Publication statusPublished - 2020

Keywords

  • Cervical cancer
  • LACC
  • Laparoscopy
  • Minimally invasive surgery
  • Predictors
  • Recurrence

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

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