Limited Survival Benefit of Preoperative Conization Before Radical Surgery in Stage IB Cervical Cancer: An...

Cervical cancer remains a major global health burden. Preoperative conization has been proposed to reduce tumor burden and potential intraoperative tumor dissemination, but its survival benefit in patients with stage IB cervical cancer remains uncertain. This study aimed to evaluate the association between preoperative conization and survival outcomes after radical surgery in patients with FIGO 2018 stage IB cervical cancer.

This retrospective study included 1,614 patients with FIGO 2018 stage IB1-IB3 cervical cancer who underwent radical surgery between 2007 and 2016 at a single center. Patients were classified into four groups based on surgical approach and conization status. Progression-free survival (PFS) and overall survival (OS) were analyzed. Inverse probability of treatment weighting (IPTW) based on propensity scores was used to balance baseline characteristics. Survival outcomes were compared using weighted Kaplan-Meier analysis.

After IPTW adjustment, baseline covariate balance was substantially improved, although residual imbalances remained for FIGO stage, depth of stromal invasion, neoadjuvant chemotherapy, and tumor differentiation. Weighted survival analysis showed no consistent survival advantage associated with preoperative conization. In pairwise OS comparisons, the laparotomy with conization group appeared to have superior OS compared with the other groups; however, this finding should be interpreted cautiously because no death events occurred in this group, resulting in non-estimable hazard ratios for comparisons involving this group. For PFS, no significant differences were observed between groups, including laparotomy with versus without conization (HR = 2.61, 95% CI: 0.62-11.02, P = 0.54), laparoscopic surgery without conization versus laparotomy without conization (HR = 1.97, 95% CI: 0.98-3.94, P = 0.21), laparoscopic surgery with conization versus laparotomy without conization (HR = 0.84, 95% CI: 0.21-3.49, P = 1.00), laparoscopic surgery without conization versus laparotomy with conization (HR = 0.75, 95% CI: 0.18-3.08, P = 0.98), laparoscopic surgery with conization versus laparotomy with conization (HR = 0.32, 95% CI: 0.05-2.02, P = 0.60), and laparoscopic surgery with versus without conization (HR = 0.43, 95% CI: 0.12-1.59, P = 0.56).

Preoperative conization was not associated with improved OS or PFS in patients with FIGO 2018 stage IB cervical cancer undergoing radical surgery. The apparent OS advantage observed in the laparotomy with conization group was based on zero death events and non-estimable hazard ratios, and therefore should not be interpreted as definitive evidence of a survival benefit. Further prospective multicenter studies with larger conization cohorts and longer follow-up are warranted.