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Reproductive outcomes after fertility-sparing surgery for cervical cancer - results of the multicenter FERTISS study
L. Fricová, S. Kommoss, G. Scambia, G. Ferron, R. Kocián, P. Harter, LP. Anchora, AS. Bats, Z. Novàk, CB. Walter, F. Raspagliesi, E. Lambaudie, K. Bahrehmand, J. Andress, J. Klát, J. Pasternak, O. Matylevich, N. Szeterlak, L. Minář, F. Heitz, ME....
Language English Country United States
Document type Journal Article, Multicenter Study
- MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Uterine Cervical Neoplasms * surgery MeSH
- Premature Birth prevention & control etiology epidemiology MeSH
- Retrospective Studies MeSH
- Pregnancy MeSH
- Trachelectomy methods MeSH
- Pregnancy Outcome MeSH
- Fertility Preservation * methods MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
INTRODUCTION: Fertility-sparing treatment (FST) for patients with cervical cancer intends to achieve oncologic outcomes comparable to those after radical treatment while maximizing reproductive outcomes, including the ability to conceive and minimizing the risk of prematurity. METHODOLOGY: International multicentre retrospective FERTISS study focused on patients treated with FST analysed timing of FST relative to pregnancy, conception attempts and methods, abortion rates, prophylactic procedures reducing the risk of severe prematurity, pregnancy duration, and delivery mode. RESULTS: Of the 733 patients treated at 44 centres in 13 countries, 49.7% attempted to conceive during median follow-up of 72 months and 22.6% (166/733) patients achieved a successful pregnancy. Success rate was significantly higher after non-radical surgery (63.2%; 122/193) compared to radical trachelectomy (25.7%; 44/171, p < 0.001). Available perinatological data shows that 89.5% (111/124) of the patients became pregnant naturally. There was no significant difference in the abortion rate in the first pregnancy nor delivery success rates between non-radical and radical procedures patients. Preterm delivery (<38 weeks gestation) occurred more frequently after radical than non-radical procedures (76.5% vs. 57.7%, p = 0.15). Almost all patients (97.3%; 73/75) who underwent regular ultrasound cervicometry in pregnancy with subsequent prophylactic procedures delivered a live fetus, compared to 30.6% (15/49) women without such management, p < 0.001. CONCLUSION: Patients who underwent non-radical surgery had significantly higher pregnancy rates. Most pregnancies resulted in a viable fetus, but radical trachelectomy led to a higher rate of preterm births in the severe prematurity range. Half of the patients did not attempt pregnancy after FST.
Claudius Regaud Institute University Cancer Institute Toulouse 31300 France
Department of Gynecology and Gynecologic Oncology Evangelical Clinic Essen Mitte Essen 45136 Germany
Department of Gynecology and Reproductive Medicine University Hospital Jena Jena 07747 Germany
Department of Gynecology Breast Center Red Cross Clinic Munich Women's Clinic Munich 80634 Germany
Department of Gynecology Hungarian National Institute of Oncology Budapest 1122 Hungary
Department of Surgical Oncology Institut Paoli Calmettes Marseille 13009 France
Department of Women's Health Tuebingen University Hospital Tuebingen 72076 Germany
Department of Women's Health Tuebingen University Hospital Tuebingen Germany
Doctoral School of Clinical Medicine University of Szeged Hungary
Fondazione IRCCS Istituto Nazionale Tumori Milan Milan 20133 Italy
Gynecologic and Breast Oncologic Surgery Department Georges Pompidou European Hospital Paris France
Gynecology Diakonie Klinikum Schwäbisch Hall gGmbH Schwäbisch Hall 74523 Germany
References provided by Crossref.org
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- $a Fricová, Lenka $u Department of Obstetrics, Gynecology and Neonatology First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 128 08, Czech Republic
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- $a Reproductive outcomes after fertility-sparing surgery for cervical cancer - results of the multicenter FERTISS study / $c L. Fricová, S. Kommoss, G. Scambia, G. Ferron, R. Kocián, P. Harter, LP. Anchora, AS. Bats, Z. Novàk, CB. Walter, F. Raspagliesi, E. Lambaudie, K. Bahrehmand, J. Andress, J. Klát, J. Pasternak, O. Matylevich, N. Szeterlak, L. Minář, F. Heitz, ME. Căpîlna, I. Runnebaum, D. Cibula, J. Sláma
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- $a INTRODUCTION: Fertility-sparing treatment (FST) for patients with cervical cancer intends to achieve oncologic outcomes comparable to those after radical treatment while maximizing reproductive outcomes, including the ability to conceive and minimizing the risk of prematurity. METHODOLOGY: International multicentre retrospective FERTISS study focused on patients treated with FST analysed timing of FST relative to pregnancy, conception attempts and methods, abortion rates, prophylactic procedures reducing the risk of severe prematurity, pregnancy duration, and delivery mode. RESULTS: Of the 733 patients treated at 44 centres in 13 countries, 49.7% attempted to conceive during median follow-up of 72 months and 22.6% (166/733) patients achieved a successful pregnancy. Success rate was significantly higher after non-radical surgery (63.2%; 122/193) compared to radical trachelectomy (25.7%; 44/171, p < 0.001). Available perinatological data shows that 89.5% (111/124) of the patients became pregnant naturally. There was no significant difference in the abortion rate in the first pregnancy nor delivery success rates between non-radical and radical procedures patients. Preterm delivery (<38 weeks gestation) occurred more frequently after radical than non-radical procedures (76.5% vs. 57.7%, p = 0.15). Almost all patients (97.3%; 73/75) who underwent regular ultrasound cervicometry in pregnancy with subsequent prophylactic procedures delivered a live fetus, compared to 30.6% (15/49) women without such management, p < 0.001. CONCLUSION: Patients who underwent non-radical surgery had significantly higher pregnancy rates. Most pregnancies resulted in a viable fetus, but radical trachelectomy led to a higher rate of preterm births in the severe prematurity range. Half of the patients did not attempt pregnancy after FST.
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