In a Dutch retrospective cohort study reported in The Lancet Oncology, Schuurman et al identified follow-up strategies based on cytology and human papillomavirus (HPV) testing after fertility-sparing surgery for early-stage cervical cancer.
Study Details
The nationwide population-based study used data from the Netherlands Cancer Registry and the Dutch Nationwide Pathology Databank to identify all patients aged 18 to 40 years with cervical cancer who received fertility-sparing surgery between January 2000 and December 2020. The primary objective of the study was to assess the value of cervical cytology and high-risk HPV testing for predicting recurrent cervical intraepithelial neoplasia grade 2 or worse (CIN2+), including recurrent cervical cancer.
Key Findings
A total of 1,462 women (with 19,568 pathology reports) were eligible for analysis. Median age at diagnosis was 31 years (interquartile range [IQR] = 30–35 years).
After a median follow-up of 6.1 years (IQR = 3.3–10.8 years), recurrent CIN2+ was diagnosed in 128 patients (cumulative incidence = 15.0%, 95% confidence interval [CI] = 11.5%–18.2%), including 52 patients (cumulative incidence = 5.4%, 95% CI = 3.7%–7.0%) with recurrent cervical cancer. The overall 10-year recurrence-free survival for CIN2+ was 89.3% (95% CI = 87.4%–91.3%).
According to cytology findings at first follow-up within 12 months after surgery, 10-year recurrence-free survival for CIN2+ was 92.1% (95% CI = 90.2%–94.1%) in patients with normal cytology, 84.6% (95% CI = 77.4%–92.3%) in those with low-grade cytology, and 43.1% (95% CI = 26.4%–70.2%) in those with high-grade cytology.
According to high-risk HPV status at first follow-up within 12 months after surgery, 10-year recurrence-free survival for CIN2+ was 91.1% (95% CI = 85.3%–97.3%) in patients negative for high-risk HPV and 73.6% (95% CI = 58.4%–92.8%) in those positive for high-risk HPV.
Among patients negative for high-risk HPV, the cumulative incidence of recurrent CIN2+ within 6 months after any follow-up visit at 6 to 24 months was 0.0% to 0.7% among those with normal or low-grade cytology, and 0.0% to 33.3% among those with high-grade cytology. No patients negative for high-risk HPV without high-grade cytology at 6 months and 12 months developed recurrence. Among patients with high-risk HPV, the cumulative incidence of recurrence was 0.0% to 15.4% among those with normal or low-grade cytology, and 50.0% to 100% among those with high-grade cytology.
The investigators concluded, “Patients who are negative for high-risk HPV with normal or low-grade cytology at 6 to 24 months after fertility-sparing surgery could be offered a prolonged follow-up interval of 6 months. This group comprises 80% of all patients receiving fertility-sparing surgery. An interval of 12 months seems to be safe after two consecutive negative tests for high-risk HPV with an absence of high-grade cytology, which accounts for nearly 75% of all patients who receive fertility-sparing surgery.”
Nienke E. van Trommel, PhD, of the Netherlands Cancer Institute, Amsterdam, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was funded by the KWF Dutch Cancer Society. For full disclosures of the study authors, visit thelancet.com.
