810P - The influence of preoperative conization (pc) to patient’s (pts) outcome and tumor biology of cervical cancer (CC)

Background

Recent studies suggested that tumor size reduction by means of pc prior to radical surgery might improve survival outcomes (SO) in CC pts. Whether pc has a beneficial effect in CC pts undergoing radical surgery in the form of total mesometrial resection (TMMR) is unclear. Because of the prevention of intraoperative tumor spillage by performing a closed colpotomy is essential to all TMMR, we hypothesized that pc would not affect SO in TMMR pts.

Methods

We performed a retrospective analysis of data which was collected in the Leipzig Mesometrial Resection trial. All pts had been treated for primary CC staged IB1 – IVA (2018-FIGO) by open abdominal hysterectomy performed as total or extended mesometrial resection (TMMR/EMMR). Recurrence-free (RFS) and overall survival (OAS) were analyzed. Cox proportional hazards regression models (Cox-R) were built to define the effect of pc. RFS and OAS within the conization group were analyzed to determine whether there is a difference between R0 (tumor removed completely) and R1 (tumor removed incompletely) conization.

Results

542 pts were included, of which 202 had received pc. After 1:1 propensity score matching including 163 pts with conization and 163 controls, pc was associated with significantly increased RFS (95.6% vs. 82.3%, HR 3.2, p<0.001) and OAS (99.2% vs. 85.6%, HR 6.4, p<0.001). In multivariable Cox-R pc was the only independent factor affecting RFS (HR 0.3, p<0.01). Analysis of the martingale residuals in a Cox regression null-model only including tumor-size revealed a continuous increase of recurrence risk with each increment in maximum tumor diameter for pts without pc, reaching a recurrence risk of 45% at a tumor size of 70 mm. In contrast, the recurrence risk for pts who had undergone pc plateaued at 12% at a tumor size of 37 mm. The sub analysis between R0 and R1 conization pts showed no difference in RFS and OAS.

Conclusions

In this study, pc was independently associated with improved survival in CC pts treated with TMMR/EMMR. Since intraoperative tumor spillage was avoided by closed colpotomy, factors other than the prevention of local tumor cell dissemination might play a role in improving survival. There is a need of further research to understand the concrete effect of pc to tumor biology.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

UKL-Universitätsklinikum Leipzig.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.