Conization before radical hysterectomy in patients with early-stage cervical cancer: A Korean multicenter study (COBRA-R)
- Authors
- Kim, Se Ik; Nam, So Hyun; Hwangbo, Suhyun; Kim, Yeorae; Cho, Hyun-Woong; Suh, Dong Hoon; Song, Jae Yun; Kim, Jae-Weon; Choi, Chel Hun; Kim, Dae-Yeon; Lee, Maria
- Issue Date
- Jun-2023
- Publisher
- Academic Press
- Keywords
- Cervical cancer; Conization; Radical hysterectomy; Minimally invasive surgery; Laparoscopic surgery; Recurrence; Survival; Prognosis
- Citation
- Gynecologic Oncology, v.173, pp 88 - 97
- Pages
- 10
- Indexed
- SCIE
SCOPUS
- Journal Title
- Gynecologic Oncology
- Volume
- 173
- Start Page
- 88
- End Page
- 97
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/63215
- DOI
- 10.1016/j.ygyno.2023.04.015
- ISSN
- 0090-8258
1095-6859
- Abstract
- Objective
To investigate the impact of conization on survival outcomes and to identify a specific population that might benefit from conization before radical hysterectomy (RH) in patients with early-stage cervical cancer.
Methods
From six institutions in Korea, we identified node-negative, margin-negative, parametria-negative, 2009 FIGO stage IB1 cervical cancer patients who underwent primary type C RH between 2006 and 2021. The patients were divided into multiple groups based on tumor size, surgical approach, and histology. We performed a series of independent 1:1 propensity score matching and compared the survival outcomes between the conization and non-conization groups.
Results
In total, 1254 patients were included: conization (n = 355) and non-conization (n = 899). Among the matched patients with a tumor size of >2 cm, the conization group showed a significantly better 3-year disease-free survival (DFS) rate compared with the non-conization group when RH was conducted via minimally invasive surgery (MIS), in those with squamous cell carcinoma (96.3% vs. 87.4%, P = 0.007) and non-squamous cell carcinoma (97.0% vs. 74.8%, P = 0.021). However, no difference in DFS was observed between the two groups among the matched patients with a tumor size of ≤2 cm, regardless of surgical approach or histological type. In patients who underwent MIS RH, DFS significantly worsened as the residual tumor size increased (P < 0.001).
Conclusion
Cervical conization was associated with a lower recurrence rate in patients with early-stage cervical cancer with a tumor size of >2 cm who underwent primary MIS RH. Cervical conization may be performed prior to MIS RH to minimize the uterine residual tumor.
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Collections - 2. Clinical Science > Department of Obstetrics and Gynecology > 1. Journal Articles
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