Archives of Gynecology and Obstetrics

, Volume 298, Issue 3, pp 465–475 | Cite as

The safety of fertility preservation for microinvasive cervical adenocarcinoma: a meta-analysis and trial sequential analysis

  • Ying Feng
  • Zihan Zhang
  • Tong Lou
  • Shuzhen Wang
  • Huimin BaiEmail author
  • Zhenyu ZhangEmail author



This study sought to evaluate the safety of conservative treatment in the management of patients with microinvasive cervical adenocarcinoma.


The PubMed, PMC, EMBASE, Web of Science and Cochrane databases were searched to collect correlational studies published in English between January 1949 and May 2018. Series reports that evaluating the oncological prognoses of patients with microinvasive cervical adenocarcinoma who were treated with fertility-sparing surgery versus hysterectomy were pooled for meta-analysis and trial sequential analysis.


A total of 8 articles with 1256 patients were collected, including 7 retrospective reviews and 1 prospective study. Only one (0.08%) patient had parametrial involvement. Positive margins of surgical specimens were identified in 6 patients (2.2%). Lymph node metastasis was found in 5 patients (0.4%). The progression-free survival and overall survival rates were 99.3 and 98.2%. Fertility-sparing surgery had no adverse impact on recurrence or survival (P = 0.524 and 0.485, respectively). Regarding potential selection bias, significantly more patients with stage IA2 tumors than those with stage IA1 disease were treated with hysterectomy (P < 0.001). The trial sequential analysis indicated that the cumulative number of patients failed to meet the required sample size (number of patients).


The prognosis for patients with microinvasive cervical adenocarcinoma is excellent. Fertility preservation is at least appropriate for young women with stage IA1 adenocarcinoma. Further studies are still warranted to evaluate the safety of this procedure in managing patients with microinvasive cervical adenocarcinoma.


Cervical cancer Microinvasive adenocarcinoma Fertility preservation Safety 



This work is supported by the Foreign Cooperation Projects of Chinese Ministry of Science and Technology (No. 2012DFA30490), and Beijing Natural Science Foundation (No. 7172077).

Author contributions

YF: project development, data collection and management, data analysis, manuscript writing. ZZ: data collection and management, data analysis. TL: data collection and management, data analysis. SW: data collection and management, data analysis. HB: project development, data collection and management, data analysis, manuscript writing. ZZ: project development, data collection and management, data analysis, manuscript writing.


This study was funded by the Foreign Cooperation Projects of Chinese Ministry of Science and Technology (No. 2012DFA30490), and Beijing Natural Science Foundation (No. 7172077).

Compliance with ethical standards

Conflict of interest

Author Ying Feng declares that she has no conflict of interest. Author Zihan Zhang declares that she has no conflict of interest. Author Tong Lou declares that she has no conflict of interest. Author Shuzhen Wang declares that she has no conflict of interest. Author Huimin Bai declares that she has no conflict of interest. Author Zhenyu Zhang declares that he has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Supplementary material

404_2018_4799_MOESM1_ESM.tif (16.5 mb)
Supplementary material 1 (TIFF 16895 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Beijing Chao-Yang HospitalCapital Medical UniversityBeijingChina

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