Effect Of Cervical Conization Before Radical Hysterectomy On The Prognosis Of Patients With Early Cervical Cancer

Objective:To analyze the differences in survival and recurrence rates between patients with and without conization before radical surgery for early-stage cervical cancer,and to provide new ideas for improving the quality of early-stage cervical cancer treatment.Methods:The data of patients who underwent radical hysterectomy in the Affiliated Hospital of Jining Medical College from May 1,2013 to December 31,2020 were collected.After sorting out,they were divided into a conization group and a non-conization group according to whether or not the radical hysterectomy was performed..The general situation,postoperative clinicopathological features,recurrence and survival of 452 patients were collected and analyzed in the general population and the population receiving minimally invasive laparoscopic and laparoscopic surgery.Differences in continuous variables between two groups were analyzed using t test or Mann-Whitney U test.Pearson’s chi-square test and Fisher’s exact test were used for comparison of categorical variables.The survival outcomes of patients in the two groups were compared using Kaplan-Meier analysis and log-rank test.Cox proportional hazards regression models were constructed to calculate adjusted hazard ratios(AHRS)and 95% confidence intervals(CI).Results:In the total population: univariate analysis showed that cervical conization(P=0.020),initial tumor size(P=0.001),and initial tumor size greater than 2 cm(P=0.021)were associated with recurrence,and no factors associated with death were observed.In the multifactorial analysis,conization(P=0.037)was able to significantly reduce the risk of recurrence in the class I adjustment mode,and no factors associated with death were observed in the multifactorial analysis.The 5-year disease-free survival(DFS)was 90.3% and 86.4% in the conization and non-conization groups,respectively(P=0.011),with no difference in the site of recurrence between the two groups(P=0.367),and the 5-year overall survival(OS)was 97.7% and 93.2%,respectively(P= 0.136).In the open surgery population: 5-year DFS was 90.5% and 86.4% in the tapered and non-tapered groups,respectively(P=0.276),there was no difference in the site of recurrence between the two groups(P=0.082),and 5-year OS was 100.0% and 100.0% in the two groups,respectively(P=0.340).In the minimally invasive laparoscopic surgery population:univariate analysis showed that conization(P=0.042),initial tumor size(P=0.023),initial tumor size greater than 2 cm(P=0.041),and depth of infiltration(P=0.026)were associated with recurrence,and no factors related to death were found.In the multifactorial analysis,conization(P=0.033)and initial tumor size(P=0.043)were associated with recurrence in the class I adjustment mode,and in the class II adjustment mode,only initial tumor size was associated with recurrence(P=0.039),and no factors associated with death were found in the multifactorial analysis.The 5-year DFS was 94.1% and 72.4%(P=0.038)in the conectomy and non-conectomy groups,respectively,with no significant difference in the site of recurrence between the two groups(P=0.692)and5-year OS was 94.1% and 89.7%(P=0.738),respectively.Conlusions:Cervical conization before radical hysterectomy improves 5-year disease-free survival in patients with early-stage cervical cancer.