bf7b52738c44c699d9b8ec0d21df8070 pmc_9325092.pdf 784e4ef02ec52868944ca53613531a747b54c438 pmc_9325092.pdf 23b2fe46c3f2f5b825c03451468a5adbf6a6e5f7b0f0cb4d69534002e76dd60e pmc_9325092.pdf Title: Fertility-Sparing Surgery versus Radical Hysterectomy in Early Cervical Cancer: A Propensity Score Matching Analysis and Noninferiority Study Subject: Objective: Fertility-sparing surgery (FSS) is the treatment of choice for patients with early cervical cancer (ECC) and fertility desire, but survival rates compared to radical hysterectomy (RH) have been scarcely reported. The aim of this study was to analyse the oncological outcomes of FSS compared to a balanced group of standard RH. Methods: A retrospective multicentre study of ECC patients who underwent FSS or RH was carried out in 12 tertiary hospitals in Spain between January 2005 and January 2019. The experimental group included patients who underwent a simple and radical trachelectomy, and the control group included patients who underwent RH. Optimal 1:1 propensity score (PS) matching analysis was performed to balance the series. Results: The study included 222 patients with ECC; 111 (50%) were treated with FSS, and 111 (50%) were treated with RH. After PS matching, a total of 38 patients in the FSS group and 38 patients in the RH group were analysed. In both groups, the overall survival (HR 2.5; CI 0.89, 7.41) and recurrence rates (28.9% in the FSS group vs. 13.2% in RH group) were similar. The rate of disease-free survival at 5 years was 68.99% in the FSS group and 88.01% in the RH group (difference of -19.02 percentage points; 95% CI -32.08 to -5.96 for noninferiority). In the univariate analysis, only tumour size reached statistical significance. Conclusion: FSS offers excellent disease-free and overall survival in women with ECC with fertility desire and is not inferior compared to RH. Keywords: trachelectomy; early cervical cancer; fertility preservation treatment; minimally invasive surgery; radical hysterectomy; fertility-sparing surgery Author: Antoni Llueca, Maria Victoria Ibañez, Aureli Torne, Antonio Gil-Moreno, Angel Martin-Jimenez, Berta Diaz-Feijoo, Anna Serra, Maria Teresa Climent, Blanca Gil-Ibañez and on behalf of the Spain-GOG Cervical Cancer Working Group Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Jun 30 10:55:43 2022 CEST ModDate: Thu Jun 30 11:29:41 2022 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 14 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1449798 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- XNWBQL+VnURWPalladioL Type 1 Custom yes yes no 10 0 EOOWNQ+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 UTYMKY+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 OYRPNR+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 GQWIGS+CMSY10 Type 1 Builtin yes yes no 28 0 UIJACC+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 46 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 49 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes no 77 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 95 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 99 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 103 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 112 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 116 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 120 0 BCDJEE+PalatinoLinotype-BoldItalic TrueType WinAnsi yes yes no 124 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 140 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 144 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 148 0 BCDIEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 152 0 BCDJEE+PalatinoLinotype-BoldItalic TrueType WinAnsi yes yes no 158 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 174 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 178 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 182 0 BCDIEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 186 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-10-06 02:25:46 CEST RepresentationInformation: pmc_9325092.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-10-02 02:26:12 CEST Size: 1449798 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 346 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Children: Item: Title: Study Design Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Statistical Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Children: Item: Title: Unmatched Series Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: Recurrence Patients Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Item: Title: Matched Series Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@a38d7a3 Item: Title: Survival Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77f99a05 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@63440df3 Item: Title: Strengths and Weaknesses Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@3aeaafa6 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@76a3e297 Info: Title: Fertility-Sparing Surgery versus Radical Hysterectomy in Early Cervical Cancer: A Propensity Score Matching Analysis and Noninferiority Study Author: Antoni Llueca, Maria Victoria Ibañez, Aureli Torne, Antonio Gil-Moreno, Angel Martin-Jimenez, Berta Diaz-Feijoo, Anna Serra, Maria Teresa Climent, Blanca Gil-Ibañez and on behalf of the Spain-GOG Cervical Cancer Working Group Subject: Objective: Fertility-sparing surgery (FSS) is the treatment of choice for patients with early cervical cancer (ECC) and fertility desire, but survival rates compared to radical hysterectomy (RH) have been scarcely reported. The aim of this study was to analyse the oncological outcomes of FSS compared to a balanced group of standard RH. Methods: A retrospective multicentre study of ECC patients who underwent FSS or RH was carried out in 12 tertiary hospitals in Spain between January 2005 and January 2019. The experimental group included patients who underwent a simple and radical trachelectomy, and the control group included patients who underwent RH. Optimal 1:1 propensity score (PS) matching analysis was performed to balance the series. Results: The study included 222 patients with ECC; 111 (50%) were treated with FSS, and 111 (50%) were treated with RH. After PS matching, a total of 38 patients in the FSS group and 38 patients in the RH group were analysed. In both groups, the overall survival (HR 2.5; CI 0.89, 7.41) and recurrence rates (28.9% in the FSS group vs. 13.2% in RH group) were similar. The rate of disease-free survival at 5 years was 68.99% in the FSS group and 88.01% in the RH group (difference of -19.02 percentage points; 95% CI -32.08 to -5.96 for noninferiority). In the univariate analysis, only tumour size reached statistical significance. Conclusion: FSS offers excellent disease-free and overall survival in women with ECC with fertility desire and is not inferior compared to RH. Keywords: trachelectomy; early cervical cancer; fertility preservation treatment; minimally invasive surgery; radical hysterectomy; fertility-sparing surgery Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Jun 30 10:55:43 CEST 2022 ModDate: Thu Jun 30 11:29:41 CEST 2022 ID: 0xe112e2018cf7a071e5003af1e5b59f71, 0xe112e2018cf7a071e5003af1e5b59f71 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: UTYMKY+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 246 FontDescriptor: FontName: UTYMKY+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: OYRPNR+URWPalladioL-Ital FontSubset: true FirstChar: 46 LastChar: 121 FontDescriptor: FontName: OYRPNR+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: XNWBQL+VnURWPalladioL FontSubset: true FirstChar: 146 LastChar: 226 FontDescriptor: FontName: XNWBQL+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: GQWIGS+CMSY10 FontSubset: true FirstChar: 0 LastChar: 21 FontDescriptor: FontName: GQWIGS+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true Font: BaseFont: QLBIEB+URWPalladioL-BoldItal FontSubset: true FirstChar: 110 LastChar: 112 FontDescriptor: FontName: QLBIEB+URWPalladioL-BoldItal Flags: Symbolic FontBBox: -170, -300, 1073, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: EOOWNQ+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 241 FontDescriptor: FontName: EOOWNQ+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 82, 323, 152, 332 Annotation: Subtype: Link Rect: 34, 311, 103, 320 Annotation: Subtype: Link Rect: 34, 164, 96, 186 Annotation: Subtype: Link Rect: 126, 90, 154, 99 Annotation: Subtype: Link Rect: 34, 78, 147, 87 Annotation: Subtype: Link Rect: 34, 756, 176, 792 Annotation: Subtype: Link Rect: 515, 756, 560, 792 Annotation: Subtype: Link Rect: 119, 642, 130, 655 Annotation: Subtype: Link Rect: 238, 642, 250, 655 Annotation: Subtype: Link Rect: 317, 642, 328, 655 Annotation: Subtype: Link Rect: 432, 642, 443, 655 Annotation: Subtype: Link Rect: 120, 629, 131, 643 Annotation: Subtype: Link Rect: 514, 74, 521, 83 ActionDest: 198 Annotation: Subtype: Link Rect: 524, 74, 531, 83 ActionDest: 198 Annotation: Subtype: Link Rect: 130, 17, 268, 28 Annotation: Subtype: Link Rect: 423, 17, 560, 28 Annotation: Subtype: Link Rect: 34, 468, 87, 487 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 299, 685, 306, 694 ActionDest: 198 Annotation: Subtype: Link Rect: 307, 685, 314, 694 ActionDest: 198 Annotation: Subtype: Link Rect: 206, 660, 213, 669 ActionDest: 198 Annotation: Subtype: Link Rect: 379, 610, 386, 619 ActionDest: 198 Annotation: Subtype: Link Rect: 195, 560, 202, 569 ActionDest: 198 Annotation: Subtype: Link Rect: 348, 332, 355, 342 ActionDest: 198 Annotation: Subtype: Link Rect: 401, 194, 408, 203 ActionDest: 198 Annotation: Subtype: Link Rect: 408, 194, 415, 203 ActionDest: 198 Annotation: Subtype: Link Rect: 401, 156, 413, 166 ActionDest: 198 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 378, 560, 390, 568 ActionDest: 198 Annotation: Subtype: Link Rect: 195, 221, 207, 229 ActionDest: 198 Annotation: Subtype: Link Rect: 396, 107, 408, 117 ActionDest: 198 Annotation: Subtype: Link Rect: 411, 107, 423, 117 ActionDest: 201 Annotation: Subtype: Link Rect: 530, 108, 537, 117 ActionDest: 198 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 221, 695, 347, 707 Annotation: Subtype: Link Rect: 459, 698, 471, 707 ActionDest: 201 Annotation: Subtype: Link Rect: 545, 698, 557, 707 ActionDest: 201 Annotation: Subtype: Link Rect: 224, 685, 236, 694 ActionDest: 201 Annotation: Subtype: Link Rect: 298, 673, 309, 682 ActionDest: 201 Annotation: Subtype: Link Rect: 375, 673, 387, 682 ActionDest: 201 Annotation: Subtype: Link Rect: 475, 673, 487, 682 ActionDest: 201 Annotation: Subtype: Link Rect: 190, 546, 197, 556 ActionDest: 81 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 190, 294, 197, 303 ActionDest: 84 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 263, 260, 271, 271 ActionDest: 81 Annotation: Subtype: Link Rect: 273, 246, 280, 258 ActionDest: 87 Annotation: Subtype: Link Rect: 416, 196, 423, 208 ActionDest: 84 Annotation: Subtype: Link Rect: 262, 71, 269, 83 ActionDest: 81 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 275, 695, 282, 707 ActionDest: 87 Annotation: Subtype: Link Rect: 484, 670, 491, 682 ActionDest: 81 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 387, 720, 394, 732 ActionDest: 129 Annotation: Subtype: Link Rect: 393, 112, 400, 124 ActionDest: 132 Page: Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 475, 265, 482, 277 ActionDest: 132 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 486, 720, 493, 732 ActionDest: 163 Annotation: Subtype: Link Rect: 213, 353, 220, 365 ActionDest: 163 Annotation: Subtype: Link Rect: 196, 278, 202, 290 ActionDest: 166 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 404, 400, 411, 412 ActionDest: 166 Annotation: Subtype: Link Rect: 276, 378, 288, 387 ActionDest: 201 Annotation: Subtype: Link Rect: 544, 290, 556, 299 ActionDest: 201 Annotation: Subtype: Link Rect: 356, 227, 368, 236 ActionDest: 201 Annotation: Subtype: Link Rect: 544, 202, 556, 211 ActionDest: 201 Annotation: Subtype: Link Rect: 240, 114, 252, 123 ActionDest: 201 Annotation: Subtype: Link Rect: 545, 101, 557, 111 ActionDest: 201 Annotation: Subtype: Link Rect: 519, 77, 531, 85 ActionDest: 201 Page: Sequence: 12 Annotations: Annotation: Subtype: Link Rect: 424, 660, 431, 669 ActionDest: 198 Annotation: Subtype: Link Rect: 431, 660, 443, 669 ActionDest: 201 Annotation: Subtype: Link Rect: 545, 597, 557, 606 ActionDest: 201 Annotation: Subtype: Link Rect: 528, 547, 535, 556 ActionDest: 198 Annotation: Subtype: Link Rect: 206, 484, 218, 493 ActionDest: 201 Annotation: Subtype: Link Rect: 378, 457, 385, 469 ActionDest: 132 Annotation: Subtype: Link Rect: 461, 145, 473, 154 ActionDest: 201 Page: Sequence: 13 Annotations: Annotation: Subtype: Link Rect: 536, 413, 560, 424 Annotation: Subtype: Link Rect: 56, 402, 217, 413 Annotation: Subtype: Link Rect: 338, 402, 376, 413 Annotation: Subtype: Link Rect: 220, 367, 258, 378 Annotation: Subtype: Link Rect: 264, 367, 300, 378 Annotation: Subtype: Link Rect: 153, 333, 338, 344 Annotation: Subtype: Link Rect: 458, 333, 496, 344 Annotation: Subtype: Link Rect: 502, 333, 538, 344 Annotation: Subtype: Link Rect: 261, 310, 297, 321 Annotation: Subtype: Link Rect: 322, 264, 360, 275 Annotation: Subtype: Link Rect: 520, 241, 557, 252 Annotation: Subtype: Link Rect: 248, 206, 437, 217 Annotation: Subtype: Link Rect: 59, 195, 96, 206 Annotation: Subtype: Link Rect: 263, 172, 443, 183 Annotation: Subtype: Link Rect: 59, 161, 96, 171 Annotation: Subtype: Link Rect: 102, 161, 138, 171 Annotation: Subtype: Link Rect: 237, 137, 273, 148 Annotation: Subtype: Link Rect: 95, 115, 132, 125 Page: Sequence: 14 Annotations: Annotation: Subtype: Link Rect: 409, 733, 560, 744 Annotation: Subtype: Link Rect: 56, 722, 90, 733 Annotation: Subtype: Link Rect: 215, 722, 253, 733 Annotation: Subtype: Link Rect: 259, 722, 295, 733 Annotation: Subtype: Link Rect: 380, 687, 561, 698 Annotation: Subtype: Link Rect: 181, 676, 218, 687 Annotation: Subtype: Link Rect: 471, 641, 560, 652 Annotation: Subtype: Link Rect: 56, 629, 153, 640 Annotation: Subtype: Link Rect: 278, 629, 316, 640 Annotation: Subtype: Link Rect: 184, 595, 440, 606 Annotation: Subtype: Link Rect: 59, 584, 96, 594 Annotation: Subtype: Link Rect: 441, 572, 560, 583 Annotation: Subtype: Link Rect: 56, 560, 119, 571 Annotation: Subtype: Link Rect: 179, 537, 355, 548 Annotation: Subtype: Link Rect: 230, 514, 364, 525 Annotation: Subtype: Link Rect: 56, 491, 257, 502 Annotation: Subtype: Link Rect: 125, 457, 310, 468 Annotation: Subtype: Link Rect: 435, 457, 473, 468 Annotation: Subtype: Link Rect: 479, 457, 515, 468 Annotation: Subtype: Link Rect: 86, 422, 271, 433 Annotation: Subtype: Link Rect: 396, 422, 434, 433 Annotation: Subtype: Link Rect: 269, 376, 448, 387 Annotation: Subtype: Link Rect: 59, 366, 96, 376 Annotation: Subtype: Link Rect: 410, 342, 560, 353 Annotation: Subtype: Link Rect: 56, 330, 90, 341 Annotation: Subtype: Link Rect: 211, 330, 249, 341 Annotation: Subtype: Link Rect: 125, 296, 310, 307 Annotation: Subtype: Link Rect: 431, 296, 468, 307 Annotation: Subtype: Link Rect: 259, 261, 444, 272 Annotation: Subtype: Link Rect: 59, 251, 96, 261 Annotation: Subtype: Link Rect: 102, 251, 138, 261 Annotation: Subtype: Link Rect: 56, 215, 241, 226 Annotation: Subtype: Link Rect: 362, 215, 399, 226 Annotation: Subtype: Link Rect: 405, 215, 441, 226 Annotation: Subtype: Link Rect: 411, 181, 449, 192 Annotation: Subtype: Link Rect: 455, 181, 491, 192 Annotation: Subtype: Link Rect: 125, 146, 310, 157 Annotation: Subtype: Link Rect: 435, 146, 473, 157 Annotation: Subtype: Link Rect: 479, 146, 515, 157 Checksum: 13b08582 Type: CRC32 Checksum: bf7b52738c44c699d9b8ec0d21df8070 Type: MD5 Checksum: 784e4ef02ec52868944ca53613531a747b54c438 Type: SHA-1