Correction to: The impact of low-volume metastasis on disease-free survival of women with early-stage cervical cancer

Background: Recently, it has been sustained that only surgeons skilled in minimally invasive radical hysterectomy (MI-RH) could provide valuable oncological outcomes in early-stage cervical cancer. Still, literature lacks data correlating surgeon experience with patient survival rate. We aimed to investigate the impact of surgeon training on this rate. Methods: This is a retrospective study of 243 early-stage cervical cancer treated with MI-RH. Multiple regression analyses were undertaken to investigate the impact of the surgeons learning curve, according to the number of MI-RH, on patients prognosis. Results: A steady trend of reduction in disease recurrence risk is associated with increased surgeon experience. The peak of the learning curve was shown at the 19th MI-RH (hazard ratio of disease-free survival: 0.321; 95%CI: 0.140-0.737; p= 0.007). The 3 years disease-free survival that a surgeon could provide to patients is significantly lower at the beginning of his/her learning path comparing to what he/she could guarantee once adequate experience had been achieved (75.4% and 91.6% respectively, p=0.005). Surgeon experience appears to be an independent prognostic factor. Conclusion: The experience that a surgeon can achieve practicing in MI-RH significantly influences oncological outcomes of early-stage cervical cancer patients. Future studies comparing minimally invasive and open surgery should take this into account. It would be advisable that the scientific community precisely establishes the minimum training required in the field of MI-RH for early-stage cervical cancer.

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154 Disease-free survival in early-stage cervical cancer: comparison of laparoscopic versus open surgery in a tertiary centre

10.1136/ijgc-2020-esgo.11 ◽

2020 ◽

Author(s):

Amanda Veiga-Fernández ◽

María López-Altuna ◽

Ignacio Romero-Martínez ◽

Elsa Mendizábal Vicente ◽

Patricia Rincon Olbes ◽

...

Keyword(s):

Cervical Cancer ◽

Open Surgery ◽

Early Stage ◽

Disease Free Survival ◽

Free Survival ◽

Tertiary Centre ◽

Early Stage Cervical Cancer ◽

Disease Free

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Oncological outcomes of laparoscopic radical hysterectomy versus radical abdominal hysterectomy in patients with early-stage cervical cancer: a multicenter analysis

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-002086 ◽

2021 ◽

pp. ijgc-2020-002086

Author(s):

Juliana Rodriguez ◽

Jose Alejandro Rauh-Hain ◽

James Saenz ◽

David Ortiz Isla ◽

Gabriel Jaime Rendon Pereira ◽

...

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Early Stage ◽

Disease Free Survival ◽

Free Survival ◽

Laparoscopic Radical Hysterectomy ◽

Oncological Outcomes ◽

Early Stage Cervical Cancer ◽

Laparotomy Group ◽

Disease Free

IntroductionRecent evidence has shown adverse oncological outcomes when minimally invasive surgery is used in early-stage cervical cancer. The objective of this study was to compare disease-free survival in patients that had undergone radical hysterectomy and pelvic lymphadenectomy, either by laparoscopy or laparotomy.MethodsWe performed a multicenter, retrospective cohort study of patients with cervical cancer stage IA1 with lymph-vascular invasion, IA2, and IB1 (FIGO 2009 classification), between January 1, 2006 to December 31, 2017, at seven cancer centers from six countries. We included squamous, adenocarcinoma, and adenosquamous histologies. We used an inverse probability of treatment weighting based on propensity score to construct a weighted cohort of women, including predictor variables selected a priori with the possibility of confounding the relationship between the surgical approach and survival. We estimated the HR for all-cause mortality after radical hysterectomy with weighted Cox proportional hazard models.ResultsA total of 1379 patients were included in the final analysis, with 681 (49.4%) operated by laparoscopy and 698 (50.6%) by laparotomy. There were no differences regarding the surgical approach in the rates of positive vaginal margins, deep stromal invasion, and lymphovascular space invasion. Median follow-up was 52.1 months (range, 0.8–201.2) in the laparoscopic group and 52.6 months (range, 0.4–166.6) in the laparotomy group. Women who underwent laparoscopic radical hysterectomy had a lower rate of disease-free survival compared with the laparotomy group (4-year rate, 88.7% vs 93.0%; HR for recurrence or death from cervical cancer 1.64; 95% CI 1.09–2.46; P=0.02). In sensitivity analyzes, after adjustment for adjuvant treatment, radical hysterectomy by laparoscopy compared with laparotomy was associated with increased hazards of recurrence or death from cervical cancer (HR 1.7; 95% CI 1.13 to 2.57; P=0.01) and death for any cause (HR 2.14; 95% CI 1.05–4.37; P=0.03).ConclusionIn this retrospective multicenter study, laparoscopy was associated with worse disease-free survival, compared to laparotomy.

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Outcomes of pre-operative brachytherapy followed by hysterectomy for early cervical cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000617 ◽

2019 ◽

Vol 30 (2) ◽

pp. 181-186 ◽

Cited By ~ 1

Author(s):

Benoit Bataille ◽

Alexandre Escande ◽

Florence Le Tinier ◽

Audrey Parent ◽

Emilie Bogart ◽

...

Keyword(s):

Cervical Cancer ◽

Tumor Size ◽

Early Stage ◽

Disease Free Survival ◽

Late Toxicity ◽

Free Survival ◽

Overweight Status ◽

Early Stage Cervical Cancer ◽

Early Cervical Cancer ◽

Disease Free

ObjectiveThe standard of care for early cervical cancer is radical hysterectomy; however, consideration of pre-operative brachytherapy has been explored. We report our experience using pre-operative brachytherapy plus Wertheim-type hysterectomy to treat early stage cervical cancer.MethodsThis single-center study evaluated consecutive patients with histologically proven node-negative early stage cervical cancer (International Federation of Gynecology and Obstetrics 2009 stage IB1–IIB) that was treated using pre-operative brachytherapy and hysterectomy. Pre-brachytherapy staging was performed using magnetic resonance imaging (MRI) and pelvic lymph node assessment was performed using lymphadenectomy. The tumor and cervical tissues were treated using brachytherapy (total dose 60 Gy) followed by Wertheim-type hysterectomy. The study included patients from January 2000 to December 2013.ResultsA total of 80 patients completed a median follow-up of 6.7 years (range 5.4–8.5). The surgical specimens revealed a pathological complete response for 61 patients (76%). Patients with incomplete responses generally had less than 1 cm residual tumor at the cervix, and only one patient had lymphovascular space involvement. The estimated 5-year rates were 88% for overall survival (95% CI 78% to 94%) and 82% for disease-free survival (95% CI 71% to 89%). Toxicities were generally mild-to-moderate, including 26 cases (33%) of grade 2 late toxicity and 10 cases (13%) of grade 3 late toxicity. Univariate analyses revealed that poor disease-free survival was associated with overweight status (≥25 kg/m2, HR 3.05, 95% CI 1.20 to 7.76, p=0.019) and MRI tumor size >3 cm (HR 3.05, 95% CI 1.23 to 7.51, p=0.016).ConclusionsPre-operative brachytherapy followed by Wertheim-type hysterectomy may be safe and effective for early stage cervical cancer, although poorer outcomes were associated with overweight status and MRI tumor size >3 cm.

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PIK3CA Mutations Are Not Correlated With Worse Disease-Free Survival in Early-Stage Cervical Cancer Treated With Surgery and Could be a Target for Overcoming Resistance to Chemoradiotherapy in Locally Advanced Cervical Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2020.07.2569 ◽

2020 ◽

Vol 108 (3) ◽

pp. e456

Author(s):

Z.A. Oaks ◽

K. Tucker ◽

B. Beaty ◽

V. Bae-Jump ◽

A.A. Weiner

Keyword(s):

Cervical Cancer ◽

Early Stage ◽

Locally Advanced ◽

Disease Free Survival ◽

Advanced Cervical Cancer ◽

Free Survival ◽

Pik3ca Mutations ◽

Locally Advanced Cervical Cancer ◽

Early Stage Cervical Cancer ◽

Disease Free

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DISEASE-FREE SURVIVAL IN EARLY-STAGE CERVICAL CANCER: COMPARISON OF LAPAROSCOPIC VERSUS OPEN SURGERY IN A TERTIARY CENTRE.

10.26226/morressier.5fa3ee5d55b1fd4cc4dd938e ◽

2020 ◽

Author(s):

Amanda Veiga-Fernández

Keyword(s):

Cervical Cancer ◽

Open Surgery ◽

Early Stage ◽

Disease Free Survival ◽

Free Survival ◽

Tertiary Centre ◽

Early Stage Cervical Cancer ◽

Disease Free

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Comparison of laparoscopic versus open radical hysterectomy in patients with early-stage cervical cancer: a multicenter study in China

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001340 ◽

2020 ◽

Vol 30 (8) ◽

pp. 1143-1150

Author(s):

Ting wen yi Hu ◽

Yue Huang ◽

Na Li ◽

Dan Nie ◽

Zhengyu Li

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Radical Hysterectomy ◽

Tumor Size ◽

Early Stage ◽

Disease Free Survival ◽

Free Survival ◽

Laparoscopic Radical Hysterectomy ◽

Early Stage Cervical Cancer ◽

Disease Free

IntroductionRecently, the safety of minimally invasive surgery in the treatment of cervical cancer has been questioned. This study was designed to compare the disease-free survival and overall survival of abdominal radical hysterectomy and laparoscopic radical hysterectomy in patients with early-stage cervical cancer.MethodsA total of 1065 patients with early-stage cervical cancer who had undergone abdominal/laparoscopic radical hysterectomy between January 2013 and December 2016 in seven hospitals were retrospectively analyzed. The 1:1 propensity score matching was performed in all patients. Patients with tumor size ≥2 cm and <2 cm were stratified and analyzed separately. Disease-free survival and overall survival were compared between matched groups. After conﬁrming the normality by the Shapiro-Wilks test, the Mann-Whitney U test and the χ2 test were used for the comparison of continuous and categorical variables, respectively. The survival curves were generated by the Kaplan-Meier method and compared by log-rank test.ResultsAfter matching, a total of 812 patients were included in the disease-free survival and overall survival analyses. In the entire cohort, the laparoscopic radical hysterectomy group had a significantly shorter disease-free survival (HR 1.65, 95% CI 1.00 to 2.73; p=0.048) but not overall survival (HR 1.60, 95% CI 0.89 to 2.88; p=0.12) when compared with the abdominal radical hysterectomy group. In patients with tumor size ≥2 cm, the laparoscopic radical hysterectomy group had a significantly shorter disease-free survival (HR 1.93, 95% CI 1.05 to 3.55; p=0.032) than the abdominal radical hysterectomy group, whereas no significant difference in overall survival (HR 1.90, 95% CI 0.95 to 3.83; p=0.10) was found. Additionally, in patients with tumor size <2 cm, the laparoscopic radical hysterectomy and abdominal radical hysterectomy groups had similar disease-free survival (HR 0.71, 95% CI 0.24 to 2.16; p=0.59) and overall survival (HR 0.59, 95% CI 0.11 to 3.13; p=0.53).ConclusionLaparoscopic radical hysterectomy was associated with inferior disease-free survival compared with abdominal radical hysterectomy in the entire cohort, as well as in patients with tumor size ≥2 cm. For the surgical treatment of patients with early-stage cervical cancer, priority should be given to open abdominal radical hysterectomy.

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