Predictors of recurrence following laparoscopic radical hysterectomy for early-stage cervical cancer: A multi-institutional study.

ABSTRACT

OBJECTIVE: To assess predictors of recurrence following laparoscopic radical hysterectomy (LRH) for apparent early stage cervical cancer (CC). METHODS: This is a retrospective multi-institutional study reviewing data of consecutive patients who underwent LRH for FIGO 2009 stage IA1 (with lymphovascular space invasion (LVSI)), IA2 and IB1(≤4 cm) CC, between January 2006 and December 2017. The following histotypes were included squamous, adenosquamous, and adenocarcinoma. Multivariable models were used to estimate adjusted odds ratio (OR) and corresponding 95% CI. Factors influencing disease-free survival (DFS) and disease-specific survival (DSS) were also explored. RESULTS: 428 patients were included in the analysis. With a median follow-up of 56 months (1-162) 54 patients recurred (12.6%). At multivariable analysis, tumor size (OR1.04, 95%CI1.01-1.09, p = .02), and presence of cervical residual tumor at final pathology (OR 5.29, 95%CI1.34-20.76, p = .02) were found as predictors of recurrence; conversely preoperative conization reduced the risk (OR0.32, 95%CI0.11-0.90, p = .03). These predictors remained significant also in the IB1 subgroup tumor size OR1.05, 95%CI1.01-1.09, p = .01; residual tumor at final pathology OR 6.26, 95%CI1.58-24.83, p = .01; preoperative conization OR0.33, 95%CI0.12-0.95, p = .04. Preoperative conization (HR 0.29, 95%CI 0.13-0.91; p = .03) and the presence of residual tumor on the cervix at the time of surgery (HR 8.89; 95%CI 1.39-17.23; p = .01) independently correlated with DFS. No independent factors were associated with DSS. CONCLUSIONS: In women with early stage CC the presence of high-volume disease at time of surgery represent an independent predictor of recurrence after LRH. Conversely, preoperative conization and the absence of residual disease at the time of surgery might play a protective role.