Oncologic and obstetrical outcomes with fertility-sparing treatment of cervical cancer: a systematic review and meta-analysis
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Qing Zhang1,2,*, Wenhui Li1,5,*, Margaux J. Kanis3, Gonghua Qi1, Minghao Li4, Xingsheng Yang1 and Beihua Kong1,2
1 Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji’nan, Shandong, P.R. China
2 Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji’nan, Shandong, P.R. China
3 Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
4 Shandong University School of Medicine, Ji’nan, Shandong, P.R. China
5 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
* These authors have contributed equally to this work
Beihua Kong, email:
Xingsheng Yang, email:
Keywords: conization, radical trachelectomy, early cervical cancer, fertility-sparing treatment, live births
Received: November 04, 2016 Accepted: February 06, 2017 Published: March 15, 2017
OBJECTIVE: The objectives of this study were to evaluate the rates of recurrence, survival and pregnancy, and characterize pregnancy outcomes of early-stage cervical cancer(eCC) treated with fertility-sparing methods such as cervical conization (CON) and radical trachelectomy(RT) with or without pelvic lymphadenectomy.
STUDY DESIGN: This was a meta-analysis of observational studies analyzed by a random-effects model and a meta-regression to assess heterogeneity.
RESULTS: Sixty observational studies encompassing 2,854 patients were included; 17 of which evaluated CON and 43 RT. Three hundred and seventy-five patients were included in the CON group: 176(46.9%) stage IA1 and 167(44.5%) stage IB1. In the RT group, 2479 cases were included: 143(6.0%) stage IA1, 299(12.1%) stage IA2, 1987(79.9%) stage IB1. CON was performed in 347(92.5%) cases, resulting in a recurrence rate of 0.4%(95%CI: 0.0%-1.4%), a death rate of 0%(0%-0%), a pregnancy rate of 36.1%(26.4%-46.2%), a spontaneous abortion rate of 14.8%(9.3%-21.2%) and a preterm delivery rate of 6.8%(1.5%-15.5%). For the RT group, 2273(91.7%) underwent successful surgeries with a recurrence rate of 2.3%(1.3%-3.4%),a death rate of 0.7%(0.3%-1.1%), a pregnancy rate of 20.5%(16.8%-24.5%), a spontaneous abortion rate of 24.0%(18.8%-29.6%) and a preterm delivery rate of 26.6%(19.6%-34.2%). From a subgroup analysis, the recurrence rates for stage IA tumors treated with CON and RT were 0.4%(0.0%-1.9%) and 0.7%(0.0%-2.3%), respectively; and for stage IB were 0.6%(0.0%-2.7%) and 2.3%(0.9%-4.1%).
CONCLUSION: Fertility-sparing treatment including CON or RT for eCC is feasible and carefully selected women can preserve fertility and achieve pregnancy resulting in live births. CON seems to result in better pregnancy outcomes than RT with similar rates of recurrence and mortality.
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