Fertility-Sparing Surgery versus Standard Surgery: 5-Year Life Expectancy Disparity Revealed in new study

The study, published in the American Journal of Obstetrics and Gynecology, revealed similar outcomes in young patients with stage I cancers measuring ≤4 cm within five years of diagnosis after either fertility-sparing surgery or standard surgery.

"However, a clinically important survival difference could not be excluded in this population because few patients with tumors >2 cm underwent fertility-sparing surgery," the researchers wrote.

There is a rise in cervical cancer incidence among premenopausal women, and fertility-sparing surgery serves as an important option for this young population. The evidence on what tumor size cutoff defines candidacy for fertility-sparing surgery. To fill this knowledge gap, Kirsten A. Jorgensen, The University of Texas MD Anderson Cancer Center, Houston, TX, and colleagues aimed to describe how the association between fertility-sparing surgery (versus standard surgery) and life expectancy varies by tumor size among patients with cervical cancers measuring ≤4 cm in largest diameter. The secondary objective was to quantify the probability of undergoing adjuvant radiotherapy among patients who underwent fertility-sparing surgery as a function of tumor size.

For this purpose, the researchers identified patients in the National Cancer Database aged ≤45 years, with stage I cervical cancer with tumors ≤4 cm diagnosis between 2006 and 2018, who received no preoperative radiation or chemotherapy, and who underwent either fertility-sparing surgery (trachelectomy or cone, either simple or radical) or standard surgery (simple or radical hysterectomy) as their primary treatment.

Patients who underwent fertility-sparing surgery were compared with those who underwent standard surgery using propensity-score matching. A flexible parametric model was employed to quantify the difference in life expectancy within five years of diagnosis (restricted mean survival time) based on tumor size in patients who underwent fertility-sparing and those who underwent standard surgery.

Additionally, a logistic regression model was used to explore the relationship between tumor size and the probability of receiving adjuvant radiation among those who underwent fertility-sparing surgery.

The study led to the following findings:

• 11,946 patients met the inclusion criteria, and 904 underwent fertility-sparing surgery. After propensity-score matching, 897 patients who underwent fertility-sparing surgery were matched 1:1 with those who underwent standard surgery.
• Although the 5-year life expectancy was similar among patients who had fertility-sparing surgery and those who had standard surgery irrespective of tumor sizes, the estimates of life-expectancy differences associated with fertility-sparing surgery were more precise among patients with smaller tumors (1-cm tumor: restricted mean survival time difference, −0.10 months) versus those with larger tumors (4-cm tumor: restricted mean survival time difference, −0.11 months).
• The probability of receiving adjuvant radiation increased with tumor size, ranging from 5.6% for a 1 cm tumor to 37% for a 4 cm tumor.

Based on the findings, the researchers revealed that fertility-sparing treatment may be an option for select patients with tumors up to 4 cm in size.

Reference:

Jorgensen, K. A., Agusti, N., Wu, C., Kanbergs, A., Pareja, R., Ramirez, P. T., Rauh-Hain, J. A., & Melamed, A. (2024). Fertility-sparing surgery vs standard surgery for early-stage cervical cancer: Difference in 5-year life expectancy by tumor size. American Journal of Obstetrics and Gynecology, 230(6), 663.e1-663.e13. https://doi.org/10.1016/j.ajog.2024.02.012