The Role of Conization before Radical Hysterectomy in Cervical Cancer including High Risk Factors of Recurrence: Propensity Score Matching

SIMPLE SUMMARY: We investigated the therapeutic role of conization prior to radical hysterectomy for stage IB1 to IIB cervical cancer regardless of pathologic high risk factors, using the propensity score matching method. Additional subgroup analysis was carried out to identify the effect of conization based on clinical and pathologic factors. Conization before radical hysterectomy was associated with reduced recurrence and mortality. Conization had benefit in patients with MIS, negative pelvic lymph nodes, tumor sized less than 4 cm. Delays of definite treatment due to conization did not have an effect on the prognosis of patients with high risk factors. This study reveals the protective role of preoperative conization in early-stage cervical cancer, along with identifying subgroups that may best benefit from the procedure. This information can be used for more tailored patient selection for minimally invasive surgery for cervical cancer. ABSTRACT: We primarily aimed to investigate the therapeutic role of conization prior to radical hysterectomy for cervical cancer. Secondarily, we aimed to characterize a subgroup of patients who could potentially benefit from preoperative conization. Patients who underwent radical hysterectomy for FIGO 2009 stage IB1 to IIB cervical cancer from 1995 to 2020 were eligible. The patients were divided into two groups: those with and without preoperative conization. To adjust for the baseline characteristics of the two groups, 1:2 case–control propensity score matching was conducted. Survival analysis was performed between the two groups. Subgroup analysis was performed to identify the effect of conization based on clinical and pathological factors. Patients who underwent preoperative conization showed better 5-year overall survival than those who did not (95.9% vs. 93.0%, p = 0.029); however, no difference was observed in progression-free survival (88.9% vs. 85.9%, p = 0.155). In multivariate Cox analysis, conization showed a 55% reduction in recurrence (hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.41–1.01, p = 0.056) and 41% reduction in death (HR 0.59, 95% CI 0.34–1.02, p = 0.059), but with marginal statistical significance. In subgroup analysis, minimally invasive surgery (MIS), negative pelvic lymph node, and tumor size < 4 cm showed improved survival from conization. Conization before radical hysterectomy may be associated with improved survival in patients with early-stage cervical cancer. This information could serve as a basis for a more tailored patient selection for MIS for cervical cancer.