SUCCOR cone study: conization before radical hysterectomy
Enrique Chacon 1 , Nabil Manzour 2 , Vanna Zanagnolo 3 , Denis Querleu 4 , Jorge M Núñez-Córdoba 5 , Nerea Martin-Calvo 6 , Mihai Emil Căpîlna 7 , Anna Fagotti 8 , Ali Kucukmetin 9 , Constantijne Mom 10 , Galina Chakalova 11 , Aliyev Shamistan 12 , Antonio Gil Moreno 13 14 , Mario Malzoni 15 , Fabrice Narducci 16 , Octavio Arencibia 17 , Francesco Raspagliesi 18 , Tayfun Toptas 19 , David Cibula 20 , Dilyara Kaidarova 21 , Mehmet Mutlu Meydanli 22 , Mariana Tavares 23 , Dmytro Golub 24 , Anna Myriam Perrone 25 , Robert Poka 26 , Dimitrios Tsolakidis 27 , Goran Vujić 28 , Marcin A Jedryka 29 , Petra L M Zusterzeel 30 , Jogchum Jan Beltman 31 , Frederic Goffin 32 , Dimitrios Haidopoulos 33 , Herman Haller 34 , Robert Jach 35 , Iryna Yezhova 36 , Igor Berlev 37 , Margarida Bernardino 38 , Rasiah Bharathan 39 , Maximilian Lanner 40 , Minna M Maenpaa 41 , Vladyslav Sukhin 42 , Jean-Guillaume Feron 43 , Robert Fruscio 44 45 , Kersti Kukk 46 , Jordi Ponce 47 , Jose Angel Minguez 48 , Daniel Vázquez-Vicente 49 , Teresa Castellanos 49 , Felix Boria 50 , Juan Luis Alcazar 51 , Luis Chiva 52 , SUCCOR study group; SUCCOR study Group
Objective: To evaluate disease-free survival of cervical conization prior to radical hysterectomy in patients with stage IB1 cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009).
Methods: A multicenter retrospective observational cohort study was conducted including patients from the Surgery in Cervical Cancer Comparing Different Surgical Aproaches in Stage IB1 Cervical Cancer (SUCCOR) database with FIGO 2009 IB1 cervical carcinoma treated with radical hysterectomy between January 1, 2013, and December 31, 2014.
We used propensity score matching to minimize the potential allocation biases arising from the retrospective design. Patients who underwent conization but were similar for other measured characteristics were matched 1:1 to patients from the non-cone group using a caliper width ≤0.2 standard deviations of the logit odds of the estimated propensity score.
Results: We obtained a weighted cohort of 374 patients (187 patients with prior conization and 187 non-conization patients). We found a 65% reduction in the risk of relapse for patients who had cervical conization prior to radical hysterectomy (hazard ratio (HR) 0.35, 95% confidence interval (CI) 0.16 to 0.75, p=0.007) and a 75% reduction in the risk of death for the same sample (HR 0.25, 95% CI 0.07 to 0.90, p=0.033). In addition, patients who underwent minimally invasive surgery without prior conization had a 5.63 times higher chance of relapse compared with those who had an open approach and previous conization (HR 5.63, 95% CI 1.64 to 19.3, p=0.006).
Patients who underwent minimally invasive surgery with prior conization and those who underwent open surgery without prior conization showed no differences in relapse rates compared with those who underwent open surgery with prior cone biopsy (reference) (HR 1.94, 95% CI 0.49 to 7.76, p=0.349 and HR 2.94, 95% CI 0.80 to 10.86, p=0.106 respectively).
Conclusions: In this retrospective study, patients undergoing cervical conization before radical hysterectomy had a significantly lower risk of relapse and death.
CITATION Int J Gynecol Cancer. 2022 Feb;32(2):117-124. doi: 10.1136/ijgc-2021-002544. Epub 2022 Jan 17.