SUCCOR cone study: conization before radical hysterectomy.

Abstract

OBJECTIVE:

To evaluate disease-free survival of cervical conization prior to radical hysterectomy in patients with stage IB1 cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009).

METHODS:

A multicenter retrospective observational cohort study was conducted including patients from the Surgery in Cervical Cancer Comparing Different Surgical Aproaches in Stage IB1 Cervical Cancer (SUCCOR) database with FIGO 2009 IB1 cervical carcinoma treated with radical hysterectomy between January 1, 2013, and December 31, 2014. We used propensity score matching to minimize the potential allocation biases arising from the retrospective design. Patients who underwent conization but were similar for other measured characteristics were matched 1:1 to patients from the non-cone group using a caliper width ≤0.2 standard deviations of the logit odds of the estimated propensity score.

RESULTS:

We obtained a weighted cohort of 374 patients (187 patients with prior conization and 187 non-conization patients). We found a 65% reduction in the risk of relapse for patients who had cervical conization prior to radical hysterectomy (hazard ratio (HR) 0.35, 95% confidence interval (CI) 0.16 to 0.75, p=0.007) and a 75% reduction in the risk of death for the same sample (HR 0.25, 95% CI 0.07 to 0.90, p=0.033). In addition, patients who underwent minimally invasive surgery without prior conization had a 5.63 times higher chance of relapse compared with those who had an open approach and previous conization (HR 5.63, 95% CI 1.64 to 19.3, p=0.006). Patients who underwent minimally invasive surgery with prior conization and those who underwent open surgery without prior conization showed no differences in relapse rates compared with those who underwent open surgery with prior cone biopsy (reference) (HR 1.94, 95% CI 0.49 to 7.76, p=0.349 and HR 2.94, 95% CI 0.80 to 10.86, p=0.106 respectively).

CONCLUSIONS:

In this retrospective study, patients undergoing cervical conization before radical hysterectomy had a significantly lower risk of relapse and death.

• Authors: Enrique Chacon, Nabil Manzour, Vanna Zanagnolo, Denis Querleu, Jorge M Núñez-Córdoba, Nerea Martin-Calvo, Mihai Emil Căpîlna, Anna Fagotti, Ali Kucukmetin, Constantijne Mom, Galina Chakalova, Aliyev Shamistan, Antonio Gil Moreno, Mario Malzoni, Fabrice Narducci, Octavio Arencibia, Francesco Raspagliesi, Tayfun Toptas, David Cibula, Dilyara Kaidarova, Mehmet Mutlu Meydanli, Mariana Tavares, Dmytro Golub, Anna Myriam Perrone, Robert Poka, Dimitrios Tsolakidis, Goran Vujić, Marcin A Jedryka, Petra L M Zusterzeel, Jogchum Jan Beltman, Frederic Goffin, Dimitrios Haidopoulos, Herman Haller, Robert Jach, Iryna Yezhova, Igor Berlev, Margarida Bernardino, Rasiah Bharathan, Maximilian Lanner, Minna M Maenpaa, Vladyslav Sukhin, Jean-Guillaume Feron, Robert Fruscio, Kersti Kukk, Jordi Ponce, Jose Angel Minguez, Daniel Vázquez-Vicente, Teresa Castellanos, Felix Boria, Juan Luis Alcazar, Luis Chiva, SUCCOR study group, SUCCOR study Group
• Journal: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society (Int J Gynecol Cancer) Vol. 32 Issue 2 Pg. 117-124 (02 2022) ISSN: 1525-1438 [Electronic] England
• PMID: 35039455 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: © IGCS and ESGO 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Adult
• Conization (statistics & numerical data)
• Databases, Factual
• Disease-Free Survival
• Female
• Humans
• Hysterectomy (statistics & numerical data)
• Middle Aged
• Minimally Invasive Surgical Procedures
• Neoplasm Recurrence, Local (prevention & control)
• Propensity Score
• Retrospective Studies
• Uterine Cervical Neoplasms (pathology, surgery)