BACKGROUND: Fertility-sparing treatment in patients with cervical cancer should, in principle, follow identical algorithms to that in patients without future reproductive plans. In recent years, a trend toward nonradical procedures, such as conization or simple trachelectomy, has become apparent in medical literature, because of their associations with better pregnancy outcomes. However, the published reports included small numbers of patients and heterogenous treatment strategies to ascertain the safety of such approaches. OBJECTIVE: This study aimed to collect multi-institutional data regarding the oncological outcomes after fertility-sparing treatment in patients with cervical cancer and to identify prognostic risk factors, including the influence of the radicality of individual cervical procedures. STUDY DESIGN: Patients aged 18 to 40 years with International Federation of Gynecology and Obstetrics 2018 stage IA1 with positive lymphovascular space invasion or ≥IA2 cervical cancer who underwent any type of fertility-sparing procedure were eligible for this retrospective observational study, regardless of their histotype, tumor grade, and history of neoadjuvant chemotherapy. Associations between disease- and treatment-related characteristics with the risk of recurrence were analyzed. RESULTS: A total of 733 patients from 44 institutions across 13 countries were included in this study. Almost half of the patients had stage IB1 cervical cancer (49%), and two-thirds of patients were nulliparous (66%). After a median follow-up of 72 months, 51 patients (7%) experienced recurrence, of whom 19 (2.6%) died because of the disease. The most common sites of recurrence were the cervix (53%) and pelvic nodes (22%). The risk of recurrence was 3 times higher in patients with tumors >2 cm in size than in patients with smaller tumors, irrespective of the treatment radicality (19.4% vs 5.7%; hazard ratio, 2.982; 95% confidence interval, 1.383-6.431; P=.005). The recurrence risk in patients with tumors ≤2 cm in size did not differ between patients who underwent radical trachelectomy and patients who underwent nonradical (conization and simple trachelectomy) cervical procedures (P=.957), regardless of tumor size subcategory (<1 or 1-2 cm) or lymphovascular space invasion. CONCLUSION: Nonradical fertility-sparing cervical procedures were not associated with an increased risk of recurrence compared with radical procedures in patients with tumors ≤2 cm in size in this large, multicenter retrospective study. The risk of recurrence after any type of fertility-sparing procedure was significantly greater in patients with tumors >2 cm in size.

1st Faculty of Medicine Department of Obstetrics and Gynecology Charles University and General University Hospital Prague Czech Republic

1st Obstetrics and Gynecology Clinic George Emil Palade University of Medicine Pharmacy Science and Technology of Târgu Mureș Târgu Mureș Romania

Claudius Regaud Institute University Cancer Institute Toulouse France

Department of Gynecologic Oncology National Cancer Institute Kyiv Ukraine

Department of Gynecology and Gynecologic Oncology Kliniken Essen Mitte Essen Germany

Department of Gynecology and Obstetrics University Clinic Frankfurt Goethe University Frankfurt am Main Germany; Spital Uster Women's Hospital Uster Switzerland

Department of Gynecology and Reproductive Medicine Jena University Hospital Friedrich Schiller University Jena Germany

Department of Gynecology Hungarian National Institute of Oncology Budapest Hungary

Department of Gynecology Oncology Oscar Lambret Cancer Center Lille France

Department of Women's Health Tuebingen University Hospital Tuebingen Germany

Fondazione IRCCS Istituto Nazionale Tumori Milan Milan Italy

Gynaekologicum Bremen Bremen Germany

Gynecologic and Breast Oncologic Surgery Department Georges Pompidou European Hospital Paris France

Gynecologic Oncology Department N N Alexandrov National Cancer Centre of Belarus Minsk Belarus

Gynecologic Oncology Unit Fondazione Policlinico Universitario A Gemelli IRCCS Catholic University of the Sacred Heart Rome Rome Italy

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