Recurrence Rates in Patients With Cervical Cancer Treated With Abdominal Versus Minimally Invasive Radical Hysterectomy: A Multi-Institutional Retrospective Review Study

Author:

Uppal Shitanshu1,Gehrig Paola A.2,Peng Katherine1,Bixel Kristin L.3,Matsuo Koji4,Vetter Monica H.3,Davidson Brittany A.5,Cisa M. Paige5,Lees Brittany F.6,Brunette Laurie L.4,Tucker Katherine2,Stuart Staley Allison2,Gotlieb Walter H.7,Holloway Robert W.8,Essel Kathleen G.9,Holman Laura L.9,Goldfeld Ester10,Olawaiye Alexander10,Rose Stephen L.6

Affiliation:

1. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI

2. University of North Carolina Gynecologic Oncology, Chapel Hill, NC

3. The Ohio State University Comprehensive Cancer Center, Columbus, OH

4. University of Southern California Keck School of Medicine, Los Angeles, CA

5. Duke University, Durham, NC

6. University of Wisconsin, Madison, WI

7. McGill University, Montreal, Quebec, Canada

8. AdventHealth Medical Group GYN Oncology, Orlando FL

9. University of Oklahoma, Norman, OK

10. University of Pittsburgh, Pittsburgh, PA

Abstract

PURPOSE To compare the disease-free survival (DFS) between open and minimally invasive radical hysterectomies (RH) performed in academic medical institutions METHODS Retrospective multi-institutional review of patients undergoing RH for stage IA1 (with lymphovascular invasion), IA2, and IB1 squamous, adenocarcinoma, or adenosquamous carcinoma between January 1, 2010 and December 31, 2017. RESULTS Of 815 patients, open RH was performed in 255 cases (29.1%) and minimally invasive RH in 560 cases (70.9%). There were 19 (7.5%) recurrences in the open RH and 51 (9.1%) recurrences in the minimally invasive group ( P = .43). Risk-adjusted analysis revealed that minimally invasive RH was independently associated with an increased hazard of recurrence (aHR, 1.88; 95% CI, 1.04 to 3.25). Other factors independently associated with an increased hazard of recurrence included tumor size, grade, and adjuvant radiation. Conization before surgery was associated with lower recurrence risk (aHR, 0.4; 95% CI, 0.23 to 0.71). There was no difference in OS in the unadjusted analysis (HR, 1.14; 95% CI, 0.61 to 2.11) or after risk adjustment (aHR, 1.01; 95% CI, 0.5 to 2.2). Of 264 patients with tumors ≤ 2 cm on final pathology (excluding those with no residual tumor on final pathology), 2/82 (2.4%) recurred in the open RH group and 16/182 (8.8%) in the minimally invasive RH group ( P = .058). In propensity score matching analysis, 7/159 (4.4%) recurrences were noted in the open RH group and 18/156 (11.5%) in the minimally invasive RH group ( P = .019). Survival analysis revealed an increased risk of recurrence in the minimally invasive group in propensity-matched cohort (HR, 2.83; 95% CI, 1.1 to 7.18) CONCLUSION In this retrospective series, patients undergoing minimally invasive radical hysterectomy, including those with tumor size ≤ 2 cm on final pathology, had inferior DFS but not overall survival in the entire cohort.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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