Evaluation of reproductive and oncological outcomes after fertility-sparing surgery in cervical cancer patients with tumor > 2 cm

IF 1.2 Q3 OBSTETRICS & GYNECOLOGY

Gynecologic Oncology Reports Pub Date : 2025-02-01 DOI:10.1016/j.gore.2025.101688

Kiarash Bahrehmand , Dóra Vesztergom , Barna Budai , Dániel Lengyel , Edina Lukács , Zoltán Novák

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Abstract

Background/objectives

We aimed to evaluate the reproductive and oncological outcomes of patients who underwent fertility-sparing surgery (FSS) despite being considered suboptimal candidates due to tumor size > 2 cm with or without lymph node metastasis.

Methods

Between September 2008 and November 2021, 120 patients with early-stage cervical cancer patients who wished to preserve their fertility, were treated in our center. Out of these, 18 patients were not optimal candidates for FSS according to current guidelines. Despite our proposed radical treatment, these patients insisted on having a fertility-sparing treatment. The primary objective was to evaluate the reproductive outcomes including the method of conception, postoperative pregnancy rate, fertility preservation rate, live birth rate, and preterm delivery rate, while the secondary objective was to evaluate 5-year disease-free survival (DFS) and 5-year overall survival (OS).

Results

Out of 18 patients, 5 had lymph node metastasis and 2 of them declined adjuvant chemoradiation. Fertility sparing treatment was successful in 14/18 (77.8 %) patients. Out of the 14, 64.3 % (9/14) tried to conceive, resulting in 2 successful deliveries after in vitro fertilization resulting a live birth rate of 22.2. After a median follow-up of 143.3 months (95 % CI 66–169), the 5-year DFS and OS were 83.3 % (66.1–100) and 93.3 % (80.7–100), respectively.

Conclusions

This study highlights the possibility of FSS in patients with suboptimal tumor characteristics for fertility preservation while providing acceptable oncologic outcomes. We found that classical barriers to FSS can be challenged, balancing fertility preservation and oncological outcomes, and argue for personalized approaches to cervical cancer treatment, respecting patient priorities. Further prospective studies are warranted to establish the efficacy and safety of such approaches.

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宫颈肿瘤bbb2cm患者保生育手术后生殖及肿瘤预后评价

背景/目的：我们旨在评估接受保留生育手术（FSS）的患者的生殖和肿瘤预后，尽管由于肿瘤大小而被认为是次优候选人；2厘米，有无淋巴结转移。方法2008年9月至2021年11月，120例希望保留生育能力的早期宫颈癌患者在我中心接受治疗。根据目前的指南，其中18例患者不是FSS的最佳候选者。尽管我们建议进行根治性治疗，但这些患者坚持接受保留生育能力的治疗。主要目的是评估生殖结局，包括受孕方法、术后妊娠率、生育保存率、活产率和早产率，次要目的是评估5年无病生存期（DFS）和5年总生存期（OS）。结果18例患者中，5例发生淋巴结转移，2例辅助放化疗消退。保留生育能力的治疗在14/18（77.8%）患者中成功。在这14人中，64.3%（9/14）试图怀孕，体外受精后成功分娩2次，活产率为22.2。中位随访143.3个月后（95% CI 66-169）， 5年DFS和OS分别为83.3%（66.1-100）和93.3%（80.7-100）。结论本研究强调了FSS在提供可接受的肿瘤预后的同时，对肿瘤特征不理想的患者保留生育能力的可能性。我们发现FSS的传统障碍可以被挑战，平衡生育能力和肿瘤结果，并主张个性化的宫颈癌治疗方法，尊重患者的优先考虑。需要进一步的前瞻性研究来确定这些方法的有效性和安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gynecologic Oncology Reports OBSTETRICS & GYNECOLOGY-

CiteScore

2.00

自引率

0.00%

发文量

183

审稿时长

41 days

期刊介绍： Gynecologic Oncology Reports is an online-only, open access journal devoted to the rapid publication of narrative review articles, survey articles, case reports, case series, letters to the editor regarding previously published manuscripts and other short communications in the field of gynecologic oncology. The journal will consider papers that concern tumors of the female reproductive tract, with originality, quality, and clarity the chief criteria of acceptance.