Comparison of laparoscopic and abdominal radical hysterectomy in early stage cervical cancer patients without adjuvant treatment

Ancillary analysis of a Korean Gynecologic Oncology Group Study (KGOG 1028)

E. Sun Paik, Myong Cheol Lim, Moon Hong Kim, Yun Hwan Kim, Eun Seop Song, Seok Ju Seong, Dong Hoon Suh, Jong Min Lee, Chulmin Lee, Chel Hun Choi

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: We compared two groups of early stage cervical cancer patients treated with different surgical methods without adjuvant treatment using retrospective multicenter data previously collected for Korean Gynecologic Oncology Group (KGOG) study designed for developing prognostic models. Method: We initially assessed data from the multi-institutional cohort with early stage (IB-IIA) cervical cancer patients treated with radical hysterectomy without adjuvant treatment between 2000 and 2008. Propensity score matching was performed to compare disease-free survival (DFS) and overall survival (OS) of patients with laparoscopic to abdominal radical hysterectomy. Additionally, survival comparison was performed in patients with tumor size <2 cm. Results: After matching, 119 patients with laparoscopic radical hysterectomy were compared with 357 patients with abdominal radical hysterectomy (median follow-up of 63.9 months). Inferior DFS was observed in the laparoscopy group (HR 2.738 [95% CI 1.326–5.650], p = 0.005) with a significant difference in pelvic (HR 5.110 [95% CI 1.817–14.473], p < 0.001) and hematogenous recurrence (HR 3.171 [95% CI 1.059–9.494], p = 0.03), but OS was not significantly different between two groups (p = 0.624). In subgroup analysis in the patient with tumor size <2 cm (laparoscopy 62 vs. laparotomy 186, median follow-up of 69.1 months), laparoscopy was associated with lower rate of DFS (HR 12.987 [95% CI 1.451–116.244], p = 0.003), but no significant difference in OS was observed between groups. Regarding OS, number of events is lacking, and inferior DFS in the laparoscopy group may be compensated by better response to radiation therapy in pelvic recurrence. Conclusions: In this analysis, laparoscopic radical hysterectomy was associated with lower rates of DFS but not OS in early stage cervical cancer patients without adjuvant treatment. Further larger scale studies are needed.

Original languageEnglish
Pages (from-to)547-553
Number of pages7
JournalGynecologic Oncology
Volume154
Issue number3
DOIs
StatePublished - 1 Sep 2019

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Hysterectomy
Uterine Cervical Neoplasms
Disease-Free Survival
Laparoscopy
Survival
Therapeutics
Recurrence
Propensity Score
Laparotomy
Neoplasms
Radiotherapy

Keywords

  • Minimal invasive surgery
  • Prognoses
  • Survival analyses
  • Uterine cervical neoplasms

Cite this

Paik, E. Sun ; Lim, Myong Cheol ; Kim, Moon Hong ; Kim, Yun Hwan ; Song, Eun Seop ; Seong, Seok Ju ; Suh, Dong Hoon ; Lee, Jong Min ; Lee, Chulmin ; Choi, Chel Hun. / Comparison of laparoscopic and abdominal radical hysterectomy in early stage cervical cancer patients without adjuvant treatment : Ancillary analysis of a Korean Gynecologic Oncology Group Study (KGOG 1028). In: Gynecologic Oncology. 2019 ; Vol. 154, No. 3. pp. 547-553.
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abstract = "Objective: We compared two groups of early stage cervical cancer patients treated with different surgical methods without adjuvant treatment using retrospective multicenter data previously collected for Korean Gynecologic Oncology Group (KGOG) study designed for developing prognostic models. Method: We initially assessed data from the multi-institutional cohort with early stage (IB-IIA) cervical cancer patients treated with radical hysterectomy without adjuvant treatment between 2000 and 2008. Propensity score matching was performed to compare disease-free survival (DFS) and overall survival (OS) of patients with laparoscopic to abdominal radical hysterectomy. Additionally, survival comparison was performed in patients with tumor size <2 cm. Results: After matching, 119 patients with laparoscopic radical hysterectomy were compared with 357 patients with abdominal radical hysterectomy (median follow-up of 63.9 months). Inferior DFS was observed in the laparoscopy group (HR 2.738 [95{\%} CI 1.326–5.650], p = 0.005) with a significant difference in pelvic (HR 5.110 [95{\%} CI 1.817–14.473], p < 0.001) and hematogenous recurrence (HR 3.171 [95{\%} CI 1.059–9.494], p = 0.03), but OS was not significantly different between two groups (p = 0.624). In subgroup analysis in the patient with tumor size <2 cm (laparoscopy 62 vs. laparotomy 186, median follow-up of 69.1 months), laparoscopy was associated with lower rate of DFS (HR 12.987 [95{\%} CI 1.451–116.244], p = 0.003), but no significant difference in OS was observed between groups. Regarding OS, number of events is lacking, and inferior DFS in the laparoscopy group may be compensated by better response to radiation therapy in pelvic recurrence. Conclusions: In this analysis, laparoscopic radical hysterectomy was associated with lower rates of DFS but not OS in early stage cervical cancer patients without adjuvant treatment. Further larger scale studies are needed.",
keywords = "Minimal invasive surgery, Prognoses, Survival analyses, Uterine cervical neoplasms",
author = "Paik, {E. Sun} and Lim, {Myong Cheol} and Kim, {Moon Hong} and Kim, {Yun Hwan} and Song, {Eun Seop} and Seong, {Seok Ju} and Suh, {Dong Hoon} and Lee, {Jong Min} and Chulmin Lee and Choi, {Chel Hun}",
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Comparison of laparoscopic and abdominal radical hysterectomy in early stage cervical cancer patients without adjuvant treatment : Ancillary analysis of a Korean Gynecologic Oncology Group Study (KGOG 1028). / Paik, E. Sun; Lim, Myong Cheol; Kim, Moon Hong; Kim, Yun Hwan; Song, Eun Seop; Seong, Seok Ju; Suh, Dong Hoon; Lee, Jong Min; Lee, Chulmin; Choi, Chel Hun.

In: Gynecologic Oncology, Vol. 154, No. 3, 01.09.2019, p. 547-553.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Comparison of laparoscopic and abdominal radical hysterectomy in early stage cervical cancer patients without adjuvant treatment

T2 - Ancillary analysis of a Korean Gynecologic Oncology Group Study (KGOG 1028)

AU - Paik, E. Sun

AU - Lim, Myong Cheol

AU - Kim, Moon Hong

AU - Kim, Yun Hwan

AU - Song, Eun Seop

AU - Seong, Seok Ju

AU - Suh, Dong Hoon

AU - Lee, Jong Min

AU - Lee, Chulmin

AU - Choi, Chel Hun

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Objective: We compared two groups of early stage cervical cancer patients treated with different surgical methods without adjuvant treatment using retrospective multicenter data previously collected for Korean Gynecologic Oncology Group (KGOG) study designed for developing prognostic models. Method: We initially assessed data from the multi-institutional cohort with early stage (IB-IIA) cervical cancer patients treated with radical hysterectomy without adjuvant treatment between 2000 and 2008. Propensity score matching was performed to compare disease-free survival (DFS) and overall survival (OS) of patients with laparoscopic to abdominal radical hysterectomy. Additionally, survival comparison was performed in patients with tumor size <2 cm. Results: After matching, 119 patients with laparoscopic radical hysterectomy were compared with 357 patients with abdominal radical hysterectomy (median follow-up of 63.9 months). Inferior DFS was observed in the laparoscopy group (HR 2.738 [95% CI 1.326–5.650], p = 0.005) with a significant difference in pelvic (HR 5.110 [95% CI 1.817–14.473], p < 0.001) and hematogenous recurrence (HR 3.171 [95% CI 1.059–9.494], p = 0.03), but OS was not significantly different between two groups (p = 0.624). In subgroup analysis in the patient with tumor size <2 cm (laparoscopy 62 vs. laparotomy 186, median follow-up of 69.1 months), laparoscopy was associated with lower rate of DFS (HR 12.987 [95% CI 1.451–116.244], p = 0.003), but no significant difference in OS was observed between groups. Regarding OS, number of events is lacking, and inferior DFS in the laparoscopy group may be compensated by better response to radiation therapy in pelvic recurrence. Conclusions: In this analysis, laparoscopic radical hysterectomy was associated with lower rates of DFS but not OS in early stage cervical cancer patients without adjuvant treatment. Further larger scale studies are needed.

AB - Objective: We compared two groups of early stage cervical cancer patients treated with different surgical methods without adjuvant treatment using retrospective multicenter data previously collected for Korean Gynecologic Oncology Group (KGOG) study designed for developing prognostic models. Method: We initially assessed data from the multi-institutional cohort with early stage (IB-IIA) cervical cancer patients treated with radical hysterectomy without adjuvant treatment between 2000 and 2008. Propensity score matching was performed to compare disease-free survival (DFS) and overall survival (OS) of patients with laparoscopic to abdominal radical hysterectomy. Additionally, survival comparison was performed in patients with tumor size <2 cm. Results: After matching, 119 patients with laparoscopic radical hysterectomy were compared with 357 patients with abdominal radical hysterectomy (median follow-up of 63.9 months). Inferior DFS was observed in the laparoscopy group (HR 2.738 [95% CI 1.326–5.650], p = 0.005) with a significant difference in pelvic (HR 5.110 [95% CI 1.817–14.473], p < 0.001) and hematogenous recurrence (HR 3.171 [95% CI 1.059–9.494], p = 0.03), but OS was not significantly different between two groups (p = 0.624). In subgroup analysis in the patient with tumor size <2 cm (laparoscopy 62 vs. laparotomy 186, median follow-up of 69.1 months), laparoscopy was associated with lower rate of DFS (HR 12.987 [95% CI 1.451–116.244], p = 0.003), but no significant difference in OS was observed between groups. Regarding OS, number of events is lacking, and inferior DFS in the laparoscopy group may be compensated by better response to radiation therapy in pelvic recurrence. Conclusions: In this analysis, laparoscopic radical hysterectomy was associated with lower rates of DFS but not OS in early stage cervical cancer patients without adjuvant treatment. Further larger scale studies are needed.

KW - Minimal invasive surgery

KW - Prognoses

KW - Survival analyses

KW - Uterine cervical neoplasms

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U2 - 10.1016/j.ygyno.2019.06.023

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JO - Gynecologic oncology

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