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KMID : 1137020210320060083
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Journal of Gynecologic Oncology
2021 Volume.32 No. 6 p.83 ~ p.83
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Fertility-sparing surgery for women with stage I cervical cancer of 4 cm or larger: a systematic review
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Di Donato Violante
Caruso Giuseppe
Sassu Carolina Maria
Santangelo Giusi
Bogani Giorgio
Plotti Francesco
Sorbi Flavia
Perniola Giorgia
Palaia Innocenza
Terrin Gianluca
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Abstract
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Objective: To investigate current evidence on oncological, fertility and obstetric outcomes of patients with stage I cervical cancer of 4 cm or larger undergoing fertility-sparing surgery (FSS).
Methods: Systematic review of studies including women affected by stage I cervical cancer ≥4 cm who underwent FSS. Main outcome measures: disease-free survival (DFS), overall survival (OS), pregnancy rate, live birth rate, premature delivery rate.
Results: Fifteen studies met all eligibility criteria for this systematic review, involving 48 patients affected by cervical cancer ≥4 cm who completed FSS. Three patients (6.3%) experienced a recurrence and one of them (2.1%) died of disease. The 5-year DFS rate was 92.4%. The 5-year OS rate was 97.6%. A significantly shorter 5-year DFS was reported for high-risk patients (G3, non-squamous histotype, diameter ≥5 cm) compared with low-risk (74.7% vs. 100%; log-rank test, p=0.024). Data about fertility outcomes were available for 12 patients. Five patients out of 12 (41.7%) attempted to conceive with an estimated pregnancy rate of 80%, a live birth rate of 83.3% and a premature delivery rate of 20%.
Conclusion: Women with high tumor grade, aggressive histology and tumor size ≥5 cm have a higher risk of recurrence. Oncologic outcomes are encouraging among low-risk patients; however, the lack of high-quality studies makes it difficult to draw any firm conclusions. Prospective multicentric clinical trials with a proper selection of inclusion/exclusion criteria should be conducted in women with low-risk factors, strong desire to preserve their fertility and high likelihood to conceive.
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KEYWORD
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Fertility Preservation, Cervical Cancer, Conservative Treatment, Fertility, Neoadjuvant Chemotherapy
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