Effect of Conization Prior to Radical Hysterectomy on Overall and Progression-Free Survival in Early-Stage Cervical Cancer: A Propensity Score-Matched Analysis

TL;DR

This study finds that performing a conization procedure before radical hysterectomy may improve survival in early-stage cervical cancer patients.

Contribution

The study provides new evidence that conization before radical hysterectomy is associated with better overall survival in early-stage cervical cancer.

Findings

Conization prior to radical hysterectomy was significantly associated with improved overall survival.

The benefit of conization on progression-free survival was not statistically significant.

Subgroup analysis confirmed improved overall survival in patients without high-risk factors.

Abstract

Cervical cancer is a common cancer among women globally. For patients with early-stage disease, surgery to remove the uterus along with closely surrounding tissues (radical hysterectomy) is often the main treatment. An outpatient procedure called conization, which removes a portion of the cervix, is sometimes performed before this major surgery to confirm the diagnosis and assess the extent of cancer. Recent evidence suggests that conization performed before radical hysterectomy may also improve treatment outcome, but the benefits have not been fully understood and vary among studies. We reviewed data from patients treated at our hospital and compared those who had conization before radical hysterectomy with those who did not. We found that patients who had conization lived longer overall. These findings suggest that conization may provide an important protective effect and could help guide more personalized surgical planning for women with early-stage cervical cancer.

Objective: To evaluate the association of preoperative conization prior to radical hysterectomy (RH) with overall survival (OS) and progression-free survival (PFS) in patients with early-stage cervical cancer. Methods: We conducted a retrospective cohort study involving patients with stage IB1 cervical cancer treated by RH at Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Thailand, between January 2003 and December 2019. Propensity-score matching (1:1 ratio, caliper of 0.2 standard deviations) was used to balance covariates between patients who underwent conization (n = 314) and those who did not (n = 528). Survival outcomes were analyzed using Kaplan–Meier curves and the log-rank test. Subgroup analysis was also conducted on patients without high-risk histopathological factors, including pelvic node metastasis, parametrial invasion, and positive vaginal margins. Results: A total of 274 matched pairs were analyzed. Conization was significantly associated with improved OS (log-rank p = 0.03). For PFS, the benefit associated with conization was not demonstrated (log-rank p = 0.18). Similarly, subgroup analysis excluding patients with high-risk histopathological factors showed a significant association between conization and improved OS (log-rank p = 0.04) but not with PFS (log-rank p = 0.29). Conclusions: Conization prior to RH is significantly associated with improved OS in patients with early-stage cervical cancer, though its association with PFS remains inconclusive. These findings support the integration of conization into personalized surgical treatment strategies, with further prospective validation recommended.

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