Cancer medicine · 2025
Cervical Adenocarcinoma: What's Special About the Long-Term Reproductive and Oncological Outcomes of Fertility-Sparing Radical Trachelectomy in It?
СтатьяНазвание и аннотация: Перевод в очереди
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Gan Jingwen, Cao Dongyan, Zhou Huimei, Yu Mei, Wang Tao, Zhang Ying, Cheng Ninghai, Peng Peng, Yang Jiaxin, Huang Huifang, Shen Keng
Аннотация
OBJECTIVE: To present reproductive and oncological outcomes of radical trachelectomy (RT) in patients with cervical adenocarcinomas (AC).
METHODS: This retrospective study included 51 patients with cervical AC who underwent RT at Peking Union Medical Hospital from January 1, 2005 to June 1, 2023.
RESULTS: Five patients (9.8%) experienced cervical stenosis following RT, which likely occurred in cases of abdominal RT (50%) and virginal prophylactic cerclage (33.33%) and those without copper T intrauterine devices during RT (20%). In total, 30 patients (58.82%) attempted to conceive, and 11 (36.67%) succeeded. Five patients (45.45%) achieved pregnancy with fertility assistance. The mean surgery-pregnancy interval was 27 months (range, 17-118). Two preterm and two full-term births were achieved. With a median follow-up of 50 months (range, 7-238), seven patients (13.73%) experienced recurrence and three (5.88%) died. Six of seven patients relapsed beyond the residual cervix. The cancer recurrence rate (CRR) was 5.88% for patients with pre-cervical conization and 17.65% for those with biopsy (p = 0.250); 11.63% had human papillomavirus-associated (HPVA) disease and 25% had non-HPVA (NHPVA) (p = 0.313). The cancer death rate (CDR) was 4.65% with HPVA and 12.50% with NHPVA (p = 0.386); 13.63% had the endogenous type and 0 had the exogenous type (p = 0.04). Chemotherapy in patients with risk factors resulted in better CRR and CDR than in those without (5.88% vs. 17.65%, 0% vs. 8.82%). The cumulative 5-year recurrence-free survival (RFS) and overall survival rates were 82.03% and 94.39%, respectively.
CONCLUSION: RT in patients with AC led to an acceptable pregnancy rate but a higher CRR and lower 5-year RFS. Careful patient selection for RT, combined with adjuvant chemotherapy when indicated, is crucial to optimize the balance between reproductive and oncological outcomes in AC.
METHODS: This retrospective study included 51 patients with cervical AC who underwent RT at Peking Union Medical Hospital from January 1, 2005 to June 1, 2023.
RESULTS: Five patients (9.8%) experienced cervical stenosis following RT, which likely occurred in cases of abdominal RT (50%) and virginal prophylactic cerclage (33.33%) and those without copper T intrauterine devices during RT (20%). In total, 30 patients (58.82%) attempted to conceive, and 11 (36.67%) succeeded. Five patients (45.45%) achieved pregnancy with fertility assistance. The mean surgery-pregnancy interval was 27 months (range, 17-118). Two preterm and two full-term births were achieved. With a median follow-up of 50 months (range, 7-238), seven patients (13.73%) experienced recurrence and three (5.88%) died. Six of seven patients relapsed beyond the residual cervix. The cancer recurrence rate (CRR) was 5.88% for patients with pre-cervical conization and 17.65% for those with biopsy (p = 0.250); 11.63% had human papillomavirus-associated (HPVA) disease and 25% had non-HPVA (NHPVA) (p = 0.313). The cancer death rate (CDR) was 4.65% with HPVA and 12.50% with NHPVA (p = 0.386); 13.63% had the endogenous type and 0 had the exogenous type (p = 0.04). Chemotherapy in patients with risk factors resulted in better CRR and CDR than in those without (5.88% vs. 17.65%, 0% vs. 8.82%). The cumulative 5-year recurrence-free survival (RFS) and overall survival rates were 82.03% and 94.39%, respectively.
CONCLUSION: RT in patients with AC led to an acceptable pregnancy rate but a higher CRR and lower 5-year RFS. Careful patient selection for RT, combined with adjuvant chemotherapy when indicated, is crucial to optimize the balance between reproductive and oncological outcomes in AC.