J Gynecol Oncol.
2021 Nov;32(6):e83. 10.3802/jgo.2021.32.e83.
Fertility-sparing surgery for women with stage I cervical cancer of 4 cm or larger: a systematic review
- Donato VD
1 - Caruso G1
- Sassu CM1
- Santangelo G1
- Bogani G2
- Plotti F3
- Sorbi F4
- Perniola G1
- Palaia I1
- Terrin G1
- Angioli R3
- Panici PB1
- Muzii L1
- Affiliations
-
- 1Department of Maternal and Child Health and Urological Sciences, University of Rome Sapienza, Rome, Italy
- 2Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
- 3Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, Rome, Italy
- 4Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
- KMID: 2526277
- DOI: http://doi.org/10.3802/jgo.2021.32.e83
Abstract
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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