Lilian Gien, MD, MSc, Sunnybrook Odette Cancer Centre, University of Toronto, Ontario, Canada, discusses results from an analysis exploring the associated between tumor size and oncologic outcomes among patients with cervical cancer undergoing minimally invasive and open radical hysterectomy.

Dr Gien presented these findings at the 2023 Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer.

Transcript:

I'm Dr Lilian Gien. I'm a gynecologic oncologist at the Sunnybrook Odette Cancer Centre affiliated with the University of Toronto. I presented an abstract at the SGO Meeting on behalf of one of our residents, Dr Maria Cusimano, who unfortunately could not make it here today.

What we did was we evaluated the effect of tumor size on surgical approach and outcomes for patients who either had open or minimally invasive surgery or radical hysterectomies for early-stage cervix cancers. Earlier, our research group published in the American Journal of Obstetrics and Gynecology, a population-based data study where we took all patients within Ontario who had radical hysterectomies for early-stage cervix cancer, either done through an open surgery approach or minimally invasive (MIS) approach.

From that we found that there was a two-fold increase in the hazard of death for patients who had MIS surgery. And that was particularly in stage 1b cervix cancer patients. Now stage 1b is a very heterogeneous group. What we did for this study was that we wanted to see the effect of tumor size on the effect of outcomes using whatever surgical approach.

For this study, we took all the pathology data, abstracted it on all of these patients, and then re-imported it into our administrative databases in order to do the analysis. We only included patients that had pathology data available and that was 871 patients, approximately half was in the MIS group and half in the open surgery group.

Overall, what we found was that the overall follow-up was approximately 7 years. The number of cervix cancer deaths was 51. And what we found when we compared the 2 groups is that the open surgery group tended to have slightly older age. They had a higher risk of comorbidities. They also had higher stage and slightly larger tumors. A larger proportion of the open surgery group also had more adjuvant treatment. That showed that when you compared the two groups, the open surgery group was a poor prognosis cohort.

Despite this however, when we looked at the unadjusted hazards of death for cervix cancer comparing MIS to open, we found that there was a two-fold increase in the hazard of death for those with minimally invasive surgery. Although those in the open surgery group were a poor prognosis cohort, the MIS surgery group did worse.

Then when we looked at the relationship of tumor size and the interaction between the tumor size and surgical approach and its effect on cervix cancer death, what we found is that for the larger tumors, more than 2 cm, there is an increased hazard of death in the MIS group with a hazard ratio of 3.7. When we look at the smaller tumors, either 1 to 2 cm or less than 1 cm in size, there did not seem to be a statistically significant difference in the hazard of death, albeit the numbers of events in those 2 groups were relatively small.

In conclusion, we found that overall, there was a twofold increased risk in the hazard of cervix cancer death for those who had MIS radical hysterectomies as opposed to open surgery, even though the open surgery cohort was a poor prognostic group. There seems to be an association with tumor size and those with larger tumors tend to do worse or increase hazard risk of death.

Further analysis needs to be done in order to sort out the cutoff of that tumor size of what deems to be safe. There might be a small subgroup of patients with smaller tumors where it may be safe to do a minimally invasive radical hysterectomy, but further analysis needs to be done.

Source:

Gien LT, Cusimano MC, Poxon A, et al. Extent of Disease and Oncologic Outcomes in Cervical Cancer Patients Undergoing Minimally Invasive and Open Radical Hysterectomy. Presented at 2023 SGO Annual Meeting on Women’s Cancer; March 25-28, 2023; Ta