Oncological outcomes of patients with cervical cancer after fertility-sparing treatment – fertiss retrospective multicenter trial

Objective Fertility-sparing treatment (FST) has become a treatment option in patients with early stage cervical cancer. This study collected multi-institutional real-world data on treatment and oncological outcome.

Methods Patients with cervical cancer (18-40 years) with stages ≥IA1+LVSI who underwent any type of fertility-sparing procedure were included, regardless of neoadjuvant chemotherapy, histotype, or tumor grade. Parameters representing disease and treatment characteristics were analyzed for risk of recurrence.

Results 733 patients from 44 institutions in 13 countries were included. 49% were stage IB1 and two-thirds were nulliparous (66%). With the median follow-up 72 months recurrence occurred in 51 (7%) patients and 19 (2.6%) of them died of the disease. Risk of recurrence was 3x higher in tumors >2 cm compared to smaller tumors (19.4% vs. 5.7%; p<0.001). Most common sites of recurrence were cervix (53%) and pelvic nodes (22%). Depending on stage, conization was the most common definitive surgical procedure, ranging from 12.2% to 72.6%, and any type of radical trachelectomy was performed in 43.5% of patients (319/733, range 18.3% to 75.6%). Ratio between radical and non-radical cervical procedures showed a significant trend in favor of less radical approach (46.6% vs. 59.1%; p=0.005) between 2001–2010 and 2011–2020. Recurrence risk in tumors <2cm did not differ between patients after radical or less radical cervical procedure.

Conclusions FERTISS study represents the largest retrospective FST cohort of early stage cervical cancer patients to date. Stage-adapted radicality in FST may lead to similar DFS after less radical surgery in tumors below 2 cm.

Publication History

Article published online:
11 October 2022