In a nationwide study published in JCO Oncology Practice, Wolswinkel et al evaluated the long-term oncologic safety of fertility-sparing surgery (FSS) compared with hysterectomy in women with early-stage cervical cancer. The study—one of the largest of its kind—addresses a critical question for young patients seeking to preserve fertility while minimizing cancer recurrence risk.
Study Details
The retrospective matched cohort study analyzed data from 1,446 patients (aged 18–45 years) with Federation Internationale de Gynecologie et d’Obstetrique (FIGO) 2018 stage IA1 to IB2 cervical cancer treated between 2000 and 2022 across the Netherlands. Participants were matched 1:2 based on stage, histology, and lymph vascular space invasion. A total of 482 patients elected to have fertility-sparing surgery—which included cone biopsy, large loop excision of the transformation zone, or trachelectomy—and 964 underwent radical hysterectomy. The primary study outcomes were recurrence-free survival and overall survival.
Patients undergoing FSS tended to be younger than those in the hysterectomy group (median age = 30 vs 39 years) and were diagnosed more recently. The FSS group also had slightly smaller tumors and fewer lymph node metastases.
Key Results
Median follow-up was 8.9 years (interquartile range = 4.4–13.7 years). During the study period, recurrence occurred in 4.8% of the participants—7.1% in the FSS group and 3.6% in the hysterectomy group (hazard ratio [HR] = 2.21, 95% confidence interval [CI] = 1.38–3.56). The difference was most pronounced among women with FIGO stage IB1 disease (HR = 4.76, 95% CI = 1.92–11.83). However, overall survival did not differ between cohorts, with rates of 96.6% and 97.4% for the FSS and hysterectomy groups, respectively (HR = 1.06, 95% CI = 0.62–1.80).
The study authors concluded that despite the higher recurrence risk, fertility-sparing surgery did not compromise overall survival among women with early-stage cervical cancer, making it a viable option for patient wishing to preserve fertility.
“Our results emphasize that FSS is a potentially safe option for women with early-stage cervical cancer and the desire to have children,” they stated.
Janneke T. Wolswinkel, MD, of the Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands, is the corresponding author of the JCO Oncology Practice article.
Disclosure: For full disclosures of all study authors, visit ascopubs.org.
