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Trends in Use and Survival Associated With Fertility-Sparing Trachelectomy for Young Women With Early-Stage Cervical Cancer

Cui, Rosa, R., MD; Chen, Ling, MD, MPH; Tergas, Ana, I., MD; Hou, June, Y., MD; St. Clair, Caryn, M., MD; Neugut, Alfred, I., MD, PhD; Ananth, Cande, V., PhD, MPH; Hershman, Dawn, L., MD; Wright, Jason, D., MD

doi: 10.1097/AOG.0000000000002613
Gynecologic Oncology: Original Research: PDF Only

OBJECTIVE: To assess the trends in use of trachelectomy in the United States and to examine the outcomes of the procedure compared with hysterectomy in young women with cervical cancer.

METHODS: Data were analyzed from women younger than 50 years of age with stage IA2–IB2 cervical cancer treated with hysterectomy or trachelectomy from 2004 to 2014 who were registered in the National Cancer Database. After propensity score matching, we used Cox proportional hazard models to examine the association between treatment and survival.

RESULTS: We identified 15,150 patients with cervical cancer, including 14,714 (97.1%) who underwent hysterectomy and 436 (2.9%) who underwent trachelectomy. Trachelectomy rates increased from 1.5% in 2004 to 3.8% by 2014 (P<.001). The greatest increase in the rate of trachelectomy was seen in women younger than 30 years of age (4.6% in 2004 to 17.0% in 2014, P<.001). Among women who underwent trachelectomy, 29.6% had tumors greater than 2 cm in diameter. In a multivariable model, younger women and those more recently diagnosed were more likely to undergo trachelectomy, whereas Medicaid recipients (risk ratio 0.39, 95% CI 0.28–0.54) and the uninsured (risk ratio 0.67, 95% CI 0.45–1.00) were less likely to undergo trachelectomy. After propensity score matching, there was no association between trachelectomy and the risk of mortality (hazard ratio 1.24, 95% CI 0.70–2.22) (mortality rate was 6.0% for hysterectomy vs 5.2% for trachelectomy). Similarly, 5-year survival rates were similar between trachelectomy and hysterectomy for all of the stages examined.

CONCLUSIONS: Use of trachelectomy for early-stage cervical cancer has increased in the United States, particularly among women younger than 30 years of age. Within this population, survival is similar for trachelectomy and hysterectomy.

Use of trachelectomy for early-stage cervical cancer has increased in the United States and does not adversely affect survival.

Departments of Obstetrics and Gynecology and Medicine and the Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, the Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, and New York Presbyterian Hospital, New York, New York.

Corresponding author: Jason D. Wright, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, 8th Floor, New York, NY 10032; email: jw2459@columbia.edu.

Dr. Wright (NCI R01CA169121-01A1) and Dr. Hershman (NCI R01 CA166084) are recipients of grants and Dr. Tergas is the recipient of a fellowship (NCI R25 CA094061-11) from the National Cancer Institute.

Financial Disclosure Dr. Neugut has served as a consultant to Pfizer, Teva, Eisai, Hospira, Otsuka, and United Biosource Corporation. He is on the medical advisory board of EHE, Intl. Dr. Wright has served as a consultant for Tesaro and Clovis Oncology. The other authors did not report any potential conflicts of interest.

Presented as poster at the Society of Gynecologic Oncology's Annual Meeting on Women's Cancer, March 24–27, 2018, New Orleans, Louisiana.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.