Surgical approach, preoperative LEEP/conization and patterns of recurrence and death in low-risk cervical cancer – exploratory analysis from the CCTG CX.5/SHAPE trial
Bibliographic record
Abstract
BACKGROUND: SHAPE demonstrated that simple hysterectomy was not inferior to radical hysterectomy in patients with low-risk cervical cancer. To further understand the role of preoperative LEEP/conization, clear LEEP/conization margins and surgical approach, analyses were performed regarding patterns of recurrence and death. PATIENTS AND METHODS: Outcomes (pelvic recurrence, extrapelvic recurrence and cervical cancer-related death) by surgical approach (minimally invasive surgery [MIS] vs. open), LEEP/conization (yes vs. no, involved vs. negative margins) and residual disease in the hysterectomy specimen (yes vs. no) are described with 3-year outcome rate estimated by Kaplan-Meier method and compared by Cox models. RESULTS: With a median follow-up of 4.5 years, 25 (3.7%) recurrences (pelvic or extrapelvic) were observed from 680 patients who underwent simple (338) or radical (342) hysterectomy. At surgeons' discretion, MIS was performed in 524 (77%) and open surgery in 156 (23%). Overall, 19 recurrences occurred following MIS (3.6%) and 6 following open surgery (3.8%). Among 174 patients with clear margins after LEEP/conization, 2 (1.4%) developed pelvic recurrences after MIS and none after open surgery. Among the entire cohort, 9 patients had extrapelvic recurrence, 7/524 (1.3%) following MIS and 2/156 (1.3%) following open surgery. However, no extrapelvic recurrence occurred after either MIS or open surgery among patients who had pre-hysterectomy LEEP/conization with clear margins. With regards to cervical cancer-related deaths, all occurred after MIS (5/524, 0.95%) and none after open surgery or after previous LEEP/conization with clear margins. CONCLUSIONS: Similar rates of recurrence and death were observed between patients who underwent MIS and open surgery within the SHAPE cohort. No extrapelvic recurrences and death occurred in patients with clear margins following prior LEEP/conization, regardless of surgical approach. The concept of pre-hysterectomy LEEP/conization might help to triage the most effective surgical strategy in terms of surgical approach and radicality in low-risk cervical cancer patients to ensure safe outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".