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ORIGINAL RESEARCH article

Front. Surg.
Sec. Obstetrics and Gynecological Surgery
Volume 11 - 2024 | doi: 10.3389/fsurg.2024.1456376
This article is part of the Research Topic Changing Backgrounds and Groundbreaking Changes: Gynecological surgery in the third decade of the 21st century Volume II View all 7 articles

Adoption Strategies for Fertility-Sparing Surgery for Early-Stage Cervical Cancer Patients Based on Clinicopathological Characteristics: A Large Retrospective Cohort Study

Provisionally accepted
Ying Ning Ying Ning 1,2Xinyan Gao Xinyan Gao 1Yan Kong Yan Kong 2Yan Wang Yan Wang 2Tian Tian Tian Tian 2Yu Chen Yu Chen 1Yufei Yang Yufei Yang 1Ke Lei Ke Lei 2*Zhumei Cui Zhumei Cui 2*
  • 1 Qingdao University, Qingdao, China
  • 2 The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China

The final, formatted version of the article will be published soon.

    The demand for fertility-sparing surgery (FSS) is increasing among patients with early-stage cervical cancer (CC). This study aimed to evaluate the feasibility of local excision as an alternative to hysterectomy in stage I CC patients aged 15-39 years-commonly referred to as adolescents and young adults (AYAs)-with varying clinicopathological characteristics.Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified patients diagnosed between 2000 and 2020. We examined treatment interventions across different age groups, degrees of histological types, tumor differentiation, and tumor stages. The effect of local excision versus hysterectomy was assessed by comparing overall survival (OS) and disease-specific survival (DSS) rates.A total of 10,629 stage I AYA cervical cancer patients were included in this study. Among these patients, 24.5% underwent local excision for fertility preservation, while 67.3% underwent radical hysterectomy. For patients with cervical squamous cell carcinoma (SCC), long-term outcomes favored local excision over hysterectomy, and a similar trend was observed in those with adenosquamous cell carcinoma (ASCC). However, the prognosis was comparable among patients with cervical adenocarcinoma (AC). In patients with well-and moderate-differentiated tumors, local excision demonstrated superior OS compared to hysterectomy. No significant differences in prognosis were found between the two surgical interventions for patients with poorly differentiated and undifferentiated tumors. In stage IA patients, local excision was considered a viable alternative to hysterectomy. In stage IB1-IB2, FSS yielded prognostic outcomes comparable to those of hysterectomy. Conversely, patients with stage IB3 exhibited significantly shorter 5-year OS and DSS following local excision than those who underwent hysterectomy.In stage IA-IB2 (diameter ≤ 4 cm) AYA patients, local excision may serve as a viable option for fertility preservation. The histological type of SCC, AC, and ASCC, along with differentiation, should not serve as restrictive factors in determining fertility preservation strategies for these patients. Patients with early-stage, well-or moderately-differentiated SCC may benefit from local excision surgery, even when fertility preservation is not the primary objective.

    Keywords: Early-stage cervical cancer, Fertility Preservation, Local excision, Hysterectomy, prognosis

    Received: 03 Jul 2024; Accepted: 08 Aug 2024.

    Copyright: © 2024 Ning, Gao, Kong, Wang, Tian, Chen, Yang, Lei and Cui. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Ke Lei, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
    Zhumei Cui, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China

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