Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer

Alexander Melamed, Daniel J. Margul, Ling Chen, Nancy L. Keating, Marcela G. Del Carmen, Junhua Yang, Brandon Luke L. Seagle, Amy Alexander, Emma Barber, Laurel W. Rice, Jason D. Wright, Masha Kocherginsky, Shohreh Shahabi, J. Alejandro Rauh-Hain

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Abstract

BACKGROUND: Minimally invasive surgery was adopted as an alternative to laparotomy (open surgery) for radical hysterectomy in patients with early-stage cervical cancer before high-quality evidence regarding its effect on survival was available. We sought to determine the effect of minimally invasive surgery on all-cause mortality among women undergoing radical hysterectomy for cervical cancer. METHODS: We performed a cohort study involving women who underwent radical hysterectomy for stage IA2 or IB1 cervical cancer during the 2010-2013 period at Commission on Cancer-accredited hospitals in the United States. The study used inverse probability of treatment propensity-score weighting. We also conducted an interrupted time-series analysis involving women who underwent radical hysterectomy for cervical cancer during the 2000-2010 period, using the Surveillance, Epidemiology, and End Results program database. RESULTS: In the primary analysis, 1225 of 2461 women (49.8%) underwent minimally invasive surgery. Women treated with minimally invasive surgery were more often white, privately insured, and from ZIP Codes with higher socioeconomic status, had smaller, lower-grade tumors, and were more likely to have received a diagnosis later in the study period than women who underwent open surgery. Over a median follow-up of 45 months, the 4-year mortality was 9.1% among women who underwent minimally invasive surgery and 5.3% among those who underwent open surgery (hazard ratio, 1.65; 95% confidence interval [CI], 1.22 to 2.22; P=0.002 by the log-rank test). Before the adoption of minimally invasive radical hysterectomy (i.e., in the 2000-2006 period), the 4-year relative survival rate among women who underwent radical hysterectomy for cervical cancer remained stable (annual percentage change, 0.3%; 95% CI, -0.1 to 0.6). The adoption of minimally invasive surgery coincided with a decline in the 4-year relative survival rate of 0.8% (95% CI, 0.3 to 1.4) per year after 2006 (P=0.01 for change of trend). CONCLUSIONS: In an epidemiologic study, minimally invasive radical hysterectomy was associated with shorter overall survival than open surgery among women with stage IA2 or IB1 cervical carcinoma. (Funded by the National Cancer Institute and others.).

Original languageEnglish (US)
Pages (from-to)1905-1914
Number of pages10
JournalThe New England journal of medicine
Volume379
Issue number20
DOIs
StatePublished - Nov 15 2018

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Hysterectomy
Uterine Cervical Neoplasms
Minimally Invasive Surgical Procedures
Survival
Confidence Intervals
Survival Rate
SEER Program
Cancer Care Facilities
Propensity Score
National Cancer Institute (U.S.)
Mortality
Delayed Diagnosis
Social Class
Laparotomy
Epidemiologic Studies
Cohort Studies
Databases
Carcinoma

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Melamed, A., Margul, D. J., Chen, L., Keating, N. L., Del Carmen, M. G., Yang, J., ... Rauh-Hain, J. A. (2018). Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer. The New England journal of medicine, 379(20), 1905-1914. https://doi.org/10.1056/NEJMoa1804923
Melamed, Alexander ; Margul, Daniel J. ; Chen, Ling ; Keating, Nancy L. ; Del Carmen, Marcela G. ; Yang, Junhua ; Seagle, Brandon Luke L. ; Alexander, Amy ; Barber, Emma ; Rice, Laurel W. ; Wright, Jason D. ; Kocherginsky, Masha ; Shahabi, Shohreh ; Rauh-Hain, J. Alejandro. / Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer. In: The New England journal of medicine. 2018 ; Vol. 379, No. 20. pp. 1905-1914.
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title = "Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer",
abstract = "BACKGROUND: Minimally invasive surgery was adopted as an alternative to laparotomy (open surgery) for radical hysterectomy in patients with early-stage cervical cancer before high-quality evidence regarding its effect on survival was available. We sought to determine the effect of minimally invasive surgery on all-cause mortality among women undergoing radical hysterectomy for cervical cancer. METHODS: We performed a cohort study involving women who underwent radical hysterectomy for stage IA2 or IB1 cervical cancer during the 2010-2013 period at Commission on Cancer-accredited hospitals in the United States. The study used inverse probability of treatment propensity-score weighting. We also conducted an interrupted time-series analysis involving women who underwent radical hysterectomy for cervical cancer during the 2000-2010 period, using the Surveillance, Epidemiology, and End Results program database. RESULTS: In the primary analysis, 1225 of 2461 women (49.8{\%}) underwent minimally invasive surgery. Women treated with minimally invasive surgery were more often white, privately insured, and from ZIP Codes with higher socioeconomic status, had smaller, lower-grade tumors, and were more likely to have received a diagnosis later in the study period than women who underwent open surgery. Over a median follow-up of 45 months, the 4-year mortality was 9.1{\%} among women who underwent minimally invasive surgery and 5.3{\%} among those who underwent open surgery (hazard ratio, 1.65; 95{\%} confidence interval [CI], 1.22 to 2.22; P=0.002 by the log-rank test). Before the adoption of minimally invasive radical hysterectomy (i.e., in the 2000-2006 period), the 4-year relative survival rate among women who underwent radical hysterectomy for cervical cancer remained stable (annual percentage change, 0.3{\%}; 95{\%} CI, -0.1 to 0.6). The adoption of minimally invasive surgery coincided with a decline in the 4-year relative survival rate of 0.8{\%} (95{\%} CI, 0.3 to 1.4) per year after 2006 (P=0.01 for change of trend). CONCLUSIONS: In an epidemiologic study, minimally invasive radical hysterectomy was associated with shorter overall survival than open surgery among women with stage IA2 or IB1 cervical carcinoma. (Funded by the National Cancer Institute and others.).",
author = "Alexander Melamed and Margul, {Daniel J.} and Ling Chen and Keating, {Nancy L.} and {Del Carmen}, {Marcela G.} and Junhua Yang and Seagle, {Brandon Luke L.} and Amy Alexander and Emma Barber and Rice, {Laurel W.} and Wright, {Jason D.} and Masha Kocherginsky and Shohreh Shahabi and Rauh-Hain, {J. Alejandro}",
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Melamed, A, Margul, DJ, Chen, L, Keating, NL, Del Carmen, MG, Yang, J, Seagle, BLL, Alexander, A, Barber, E, Rice, LW, Wright, JD, Kocherginsky, M, Shahabi, S & Rauh-Hain, JA 2018, 'Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer', The New England journal of medicine, vol. 379, no. 20, pp. 1905-1914. https://doi.org/10.1056/NEJMoa1804923

Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer. / Melamed, Alexander; Margul, Daniel J.; Chen, Ling; Keating, Nancy L.; Del Carmen, Marcela G.; Yang, Junhua; Seagle, Brandon Luke L.; Alexander, Amy; Barber, Emma; Rice, Laurel W.; Wright, Jason D.; Kocherginsky, Masha; Shahabi, Shohreh; Rauh-Hain, J. Alejandro.

In: The New England journal of medicine, Vol. 379, No. 20, 15.11.2018, p. 1905-1914.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer

AU - Melamed, Alexander

AU - Margul, Daniel J.

AU - Chen, Ling

AU - Keating, Nancy L.

AU - Del Carmen, Marcela G.

AU - Yang, Junhua

AU - Seagle, Brandon Luke L.

AU - Alexander, Amy

AU - Barber, Emma

AU - Rice, Laurel W.

AU - Wright, Jason D.

AU - Kocherginsky, Masha

AU - Shahabi, Shohreh

AU - Rauh-Hain, J. Alejandro

PY - 2018/11/15

Y1 - 2018/11/15

N2 - BACKGROUND: Minimally invasive surgery was adopted as an alternative to laparotomy (open surgery) for radical hysterectomy in patients with early-stage cervical cancer before high-quality evidence regarding its effect on survival was available. We sought to determine the effect of minimally invasive surgery on all-cause mortality among women undergoing radical hysterectomy for cervical cancer. METHODS: We performed a cohort study involving women who underwent radical hysterectomy for stage IA2 or IB1 cervical cancer during the 2010-2013 period at Commission on Cancer-accredited hospitals in the United States. The study used inverse probability of treatment propensity-score weighting. We also conducted an interrupted time-series analysis involving women who underwent radical hysterectomy for cervical cancer during the 2000-2010 period, using the Surveillance, Epidemiology, and End Results program database. RESULTS: In the primary analysis, 1225 of 2461 women (49.8%) underwent minimally invasive surgery. Women treated with minimally invasive surgery were more often white, privately insured, and from ZIP Codes with higher socioeconomic status, had smaller, lower-grade tumors, and were more likely to have received a diagnosis later in the study period than women who underwent open surgery. Over a median follow-up of 45 months, the 4-year mortality was 9.1% among women who underwent minimally invasive surgery and 5.3% among those who underwent open surgery (hazard ratio, 1.65; 95% confidence interval [CI], 1.22 to 2.22; P=0.002 by the log-rank test). Before the adoption of minimally invasive radical hysterectomy (i.e., in the 2000-2006 period), the 4-year relative survival rate among women who underwent radical hysterectomy for cervical cancer remained stable (annual percentage change, 0.3%; 95% CI, -0.1 to 0.6). The adoption of minimally invasive surgery coincided with a decline in the 4-year relative survival rate of 0.8% (95% CI, 0.3 to 1.4) per year after 2006 (P=0.01 for change of trend). CONCLUSIONS: In an epidemiologic study, minimally invasive radical hysterectomy was associated with shorter overall survival than open surgery among women with stage IA2 or IB1 cervical carcinoma. (Funded by the National Cancer Institute and others.).

AB - BACKGROUND: Minimally invasive surgery was adopted as an alternative to laparotomy (open surgery) for radical hysterectomy in patients with early-stage cervical cancer before high-quality evidence regarding its effect on survival was available. We sought to determine the effect of minimally invasive surgery on all-cause mortality among women undergoing radical hysterectomy for cervical cancer. METHODS: We performed a cohort study involving women who underwent radical hysterectomy for stage IA2 or IB1 cervical cancer during the 2010-2013 period at Commission on Cancer-accredited hospitals in the United States. The study used inverse probability of treatment propensity-score weighting. We also conducted an interrupted time-series analysis involving women who underwent radical hysterectomy for cervical cancer during the 2000-2010 period, using the Surveillance, Epidemiology, and End Results program database. RESULTS: In the primary analysis, 1225 of 2461 women (49.8%) underwent minimally invasive surgery. Women treated with minimally invasive surgery were more often white, privately insured, and from ZIP Codes with higher socioeconomic status, had smaller, lower-grade tumors, and were more likely to have received a diagnosis later in the study period than women who underwent open surgery. Over a median follow-up of 45 months, the 4-year mortality was 9.1% among women who underwent minimally invasive surgery and 5.3% among those who underwent open surgery (hazard ratio, 1.65; 95% confidence interval [CI], 1.22 to 2.22; P=0.002 by the log-rank test). Before the adoption of minimally invasive radical hysterectomy (i.e., in the 2000-2006 period), the 4-year relative survival rate among women who underwent radical hysterectomy for cervical cancer remained stable (annual percentage change, 0.3%; 95% CI, -0.1 to 0.6). The adoption of minimally invasive surgery coincided with a decline in the 4-year relative survival rate of 0.8% (95% CI, 0.3 to 1.4) per year after 2006 (P=0.01 for change of trend). CONCLUSIONS: In an epidemiologic study, minimally invasive radical hysterectomy was associated with shorter overall survival than open surgery among women with stage IA2 or IB1 cervical carcinoma. (Funded by the National Cancer Institute and others.).

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Melamed A, Margul DJ, Chen L, Keating NL, Del Carmen MG, Yang J et al. Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer. The New England journal of medicine. 2018 Nov 15;379(20):1905-1914. https://doi.org/10.1056/NEJMoa1804923