Tumor Size and Oncological Outcomes in Patients with Early Cervical Cancer Treated by Fertility Preservation Surgery : A Multicenter Retrospective Cohort Study

As cervical cancer is increasingly diagnosed in women who still intend to have children, fertility-sparing surgery is arising as a treatment option for those women with early-stage cervical cancer. The aim of this study was to analyze surgical, oncological and obstetrical outcomes of fertility-sparing surgery in early cervical cancer in Spain. In our study, the tumor size was the most important negative prognostic factor in fertility-sparing surgery (FSS) in cervical cancer. Selection criteria for fertility preservation should be rigorous, especially for patients with a tumor > 2 cm, due to the worse oncological outcomes associated with such tumors. Patients with an early cervical cancer tumor > 2 cm and a desire for pregnancy should be advised against primary FSS. Background: The aim of this study was to analyze the impact of tumor size > 2 cm on oncological outcomes of fertility-sparing surgery (FSS) in early cervical cancer in a Spanish cohort. Methods: A multicenter, retrospective cohort study of early cervical cancer (stage IA1 with lymphovascular space invasion -IB1 (FIGO 2009)) patients with gestational desire who underwent FSS at 12 tertiary departments of gynecology oncology between 01/2005 and 01/2019 throughout Spain. Results: A total of 111 patients were included, 82 (73.9%) with tumors < 2 cm and 29 (26.1%) with tumors 2-4 cm. Patients' characteristics were balanced except from lymphovascular space invasion. All were intraoperative lymph node-negative. Median follow-up was 55.7 and 30.7 months, respectively. Eleven recurrences were diagnosed (9.9%), five (6.0%) and six (21.4%) (p < 0.05). The 3-year progression-free survival (PFS) was 95.7% (95%CI 87.3-98.6) and 76.9% (95% CI 55.2-89.0) (p = 0.011). Only tumor size (<2 cm vs. 2-4 cm) was found to be significant for recurrence. After adjusting for the rest of the variables, tumor size 2-4 cm showed a Hazard Ratio of 5.99 (CI 95% 1.01-35.41, p = 0.036). Conclusions: Tumor size ≥ 2 cm is the most important negative prognostic factor in this multicenter cohort of patients with early cervical cancer and gestational desire who underwent FSS in Spain.