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).

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.

Fertility-sparing surgery for women with stage I cervical cancer of 4 cm or larger. A systematic review / Di Donato, Violante; Caruso, Giuseppe; Sassu, Carolina Maria; Santangelo, Giusi; Bogani, Giorgio; Plotti, Francesco; Sorbi, Flavia; Perniola, Giorgia; Palaia, Innocenza; Terrin, Gianluca; Angioli, Roberto; Benedetti Panici, Pierluigi; Muzii, Ludovico. - In: JOURNAL OF GYNECOLOGIC ONCOLOGY. - ISSN 2005-0380. - 32:6(2021), pp. 1-12. [10.3802/jgo.2021.32.e83]

Fertility-sparing surgery for women with stage I cervical cancer of 4 cm or larger. A systematic review

Di Donato, Violante;Caruso, Giuseppe
;
Sassu, Carolina Maria;Santangelo, Giusi;Bogani, Giorgio;Perniola, Giorgia;Palaia, Innocenza;Terrin, Gianluca;Benedetti Panici, Pierluigi;Muzii, Ludovico
2021

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.
2021
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).
cervical cancer; conservative treatment; fertility; fertility preservation; neoadjuvant chemotherapy
01 Pubblicazione su rivista::01a Articolo in rivista
Fertility-sparing surgery for women with stage I cervical cancer of 4 cm or larger. A systematic review / Di Donato, Violante; Caruso, Giuseppe; Sassu, Carolina Maria; Santangelo, Giusi; Bogani, Giorgio; Plotti, Francesco; Sorbi, Flavia; Perniola, Giorgia; Palaia, Innocenza; Terrin, Gianluca; Angioli, Roberto; Benedetti Panici, Pierluigi; Muzii, Ludovico. - In: JOURNAL OF GYNECOLOGIC ONCOLOGY. - ISSN 2005-0380. - 32:6(2021), pp. 1-12. [10.3802/jgo.2021.32.e83]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1567801
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