Analysis of pathological and clinical characteristics of cervical conization according to age group in Japan

Isao Murakami; Akiko Ohno; Masae Ikeda; Hiroshi Yamashita; Mikio Mikami; Yoichi Kobayashi; Satoru Nagase; Masatoshi Yokoyama; Takayuki Enomoto; Hidetaka Katabuchi

doi:10.1016/j.heliyon.2020.e05193

Analysis of pathological and clinical characteristics of cervical conization according to age group in Japan

Heliyon. 2020 Oct 8;6(10):e05193. doi: 10.1016/j.heliyon.2020.e05193. eCollection 2020 Oct.

Authors

Affiliations

¹ Department of Obstetrics and Gynecology, National Hospital Organization Tokyo Medical Center, Japan.
² Department of Obstetrics and Gynecology, Toho University Ohashi Medical Center, Japan.
³ Department of Obstetrics and Gynecology, Tokai University School of Medicine, Japan.
⁴ Department of Obstetrics and Gynecology, Kyorin University Faculty of Medicine, Japan.
⁵ Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Japan.
⁶ Department of Obstetrics and Gynecology, Saga University Faculty of Medicine, Japan.
⁷ Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Japan.
⁸ Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Japan.

Abstract

Objective: With increased screening, more patients with precancerous or early cervical cancer are now being identified. Age at pregnancy, and thus number of patients requiring fertility preservation, have also increased, resulting in more diagnostic and therapeutic cervical conization (conization) procedures. We here investigated the pathological and clinical characteristics of patients undergoing conization, with a focus on age. The objectives of our study were to identify the risk factors potentially involved in cervical intraepithelial neoplasia (CIN) recurrence or persistence, additional treatment after conization, the effects of conization on pregnancy, and the actual status of conization in Japan.

Study design: A "Subcommittee for Investigation of Cervical Conization" within the Gynecologic Oncology Committee in the Japan Society of Obstetrics and Gynecology investigated pathological and clinical characteristics of conization at 205 institutions in Japan. We analyzed pathological and clinical characteristics according to age ≤50 and >50 years.

Results: Patients aged 20-40 years accounted for 12904 (87%) of the 14,832 study patients (median: 37 years, range: 16-88 years). However, 1838 (12.4%) were aged >50 years. The commonest post-operative diagnosis was CIN grade 3 in all age groups. Rates of invasive cancer, post-operative detection of more advanced lesions, positive surgical margins, additional treatment, and recurrence were significantly higher in patients aged ≥50 years than those aged <50 years (all p < 0.01), whereas rates of post-operative complications did not differ significantly between age groups. The relationship between cerclage and the incidence of amniorrhexis or premature birth did not differ significantly in any age group.

Conclusion: Post-conization management of patients aged ≥50 years requires considering the high rates of detection of more advanced lesions post-operatively, positive surgical margins, and recurrence. Cerclage should not be performed post-conization without careful consideration.

Keywords: Age; Cancer research; Cancer surgery; Cerclage; Cervical conization; Cervical intraepithelial neoplasia; Clinical research; Gynecology; Oncology; Pregnancy; Prognosis.