Nomogram predicting the likelihood of parametrial involvement in early-stage cervical cancer: avoiding unjustified radical hysterectomies

Background: We aimed to establish a tool predicting parametrial involvement (PI) in patients with early-stage cervical cancer and select a sub-group of patients who would most benefit from a less radical surgery. Methods: We retrospectively reviewed patients from two prospective multicentric databases—SENTICOL I and II—from 2005 to 2012. Patients with early-stage cervical cancer (FIGO 2018 IA with lympho-vascular involvement to IIA1), undergoing radical surgery (hysterectomy or trachelectomy) with bilateral sentinel lymph node (SLN) mapping with no metastatic node or PI on pre-operative imaging, were included. Results: In total, 5.2% patients (11/211) presented a histologic PI. After univariate analysis, SLN status, lympho-vascular space invasion, deep stromal invasion and tumor size were significantly associated with PI and were included in our nomogram. Our predictive model had an AUC of 0.92 (IC95% = 0.86–0.98) and presented a good calibration. A low risk group, defined according to the optimal sensitivity and specificity, presented a predicted probability of PI of 2%. Conclusion: Patients could benefit from a two-step approach. Final surgery (i.e. radical surgery and/or lymphadenectomy) would depend on the SLN status and the probability PI calculated after an initial conization with bilateral SLN mapping.

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Pre-operative surgical algorithm: sentinel lymph node biopsy as predictor of parametrial involvement in early-stage cervical cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001586 ◽

2020 ◽

Vol 30 (9) ◽

pp. 1317-1325 ◽

Cited By ~ 1

Author(s):

Vincent Balaya ◽

Arnaud Bresset ◽

Benedetta Guani ◽

Louise Benoit ◽

Laurent Magaud ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Radical Hysterectomy ◽

Radical Surgery ◽

Early Stage ◽

Low Risk ◽

Node Biopsy ◽

Parametrial Involvement ◽

Early Stage Cervical Cancer

IntroductionRadical hysterectomy is the gold standard in the management of early-stage cervical cancer. Parametrectomy aims to remove occult disease but is associated with significant surgical morbidity. Avoiding unnecessary parametrectomy in a subset of patients at low risk of parametrial involvement may decrease the incidence of such morbidity. The purpose of this study was to identify patients at low risk of parametrial involvement in early-stage cervical cancer potentially eligible for less radical surgery based on pre-operative criteria and sentinel lymph node (SLN) status.MethodsWe performed an ancillary analysis of data from two prospective trials on sentinel node biopsy for cervical cancer (SENTICOL I and II). Patients with International Federation of Gynecology and Obstetrics (FIGO) IA–IIA cervical cancer who underwent primary radical surgery and bilateral SLN mapping were identified between 2005 and 2012 from 25 French oncologic centers. Patients who underwent pre-operative brachytherapy or did not undergo radical surgery (simple trachelectomy, simple hysterectomy, or lymph node staging only) were excluded.ResultsOf 174 patients who fullfiled the inclusion criteria, 9 patients (5.2%) had parametrial involvement and 24 patients (13.8%) had positive SLN. Most patients had 2018 FIGO stage IB1 disease (86.1%) and squamous cell carcinomas (68.9%). Parametrial involvement was significantly associated with tumor size ≥20 mm on pelvic magnetic resonance imaging (MRI) (adjusted odds ratio (ORa) 9.30, 95% CI 1.71 to 50.57, p=0.01) and micrometastic or macrometastatic SLN (ORa 8.98, 95% CI 1.59 to 50.84, p=0.01). Of 114 patients with tumors <20 mm on pre-operative MRI and negative SLN after ultrastaging, only one patient had parametrial involvement (0.9%). By triaging patients with both of these criteria in a two-step surgical procedure, unjustified and contra-indicated radical hysterectomy would have been avoided in 65.5% and 8.6% of cases, respectively.ConclusionsLess radical surgery may be an option for patients with bilateral negative SLN after ultrastaging and tumors <20 mm. SLN status should be integrated into the decision-making process for tailored surgery in early-stage cervical cancer.

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Risk Factors for Parametrial Involvement in Early-Stage Cervical Cancer and Identification of Patients Suitable for Less Radical Surgery

Oncology Research and Treatment ◽

10.1159/000447335 ◽

2016 ◽

Vol 39 (7-8) ◽

pp. 432-438 ◽

Cited By ~ 7

Author(s):

Ingporn Jiamset ◽

Jitti Hanprasertpong

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Radical Surgery ◽

Early Stage ◽

Parametrial Involvement ◽

Early Stage Cervical Cancer

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Parametrial Involvement in Radical Hysterectomy Specimens for Women With Early-Stage Cervical Cancer

Obstetrics and Gynecology ◽

10.1097/aog.0b013e3181ab474d ◽

2009 ◽

Vol 114 (1) ◽

pp. 93-99 ◽

Cited By ~ 121

Author(s):

Michael Frumovitz ◽

Charlotte C. Sun ◽

Kathleen M. Schmeler ◽

Michael T. Deavers ◽

Ricardo dos Reis ◽

...

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Early Stage ◽

Parametrial Involvement ◽

Early Stage Cervical Cancer

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Nomogram Predicting Parametrial Involvement Based on the Radical Hysterectomy Specimens in the Early-Stage Cervical Cancer

Frontiers in Surgery ◽

10.3389/fsurg.2021.759026 ◽

2021 ◽

Vol 8 ◽

Author(s):

Chunbo Li ◽

Shimin Yang ◽

Keqin Hua

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Tumor Size ◽

Radical Surgery ◽

Early Stage ◽

External Validation ◽

Low Risk ◽

Cox Regression Analysis ◽

Parametrial Involvement ◽

Early Stage Cervical Cancer

Objective: Radical hysterectomy (RH) is the surgical standard for the treatment of the early-stage cervical cancer (CC). However, this procedure is associated with a high rate of adverse impact on the quality of the life of the patient. Since the rate of parametrial involvement (PI) is low for the patients with the early-stage CC, some authors believe that the patients with the early-stage CC may benefit from the less radical surgery. This study aims to estimate the incidence of the PI in the patients with the early-stage CC and establish a simple nomogram to identify a cohort of the patients with low risk of the PI who may benefit from the less radical surgery.Methods: All the patients who underwent the RH and pelvic lymphadenectomy were included from 2013 to 2018. The significant independent predictors were identified through the Cox regression analysis and then incorporated into a nomogram to predicate the PI. The calibration plots and receiver operating characteristic (ROC) curves were used to assess the predictive accuracy of the nomogram.Results: A total of 4,533 patients met the inclusion criteria and 441 women (9.7%) had the PI. The positive PI rate in the ≤2 cm group (1.2%) was significantly lower compared to >2– ≤4 cm (6.2%) or >4 cm (22.4%) groups. The multivariate analyses revealed that tumor size (p = 0.002), lymphovascular space invasion (LVSI) (p = 0.001), vaginal involvement (VI) (p < 0.001), status of the pelvic lymph nodes (PLNs) (p = 0.001), and depth of stromal invasion (DSI) (p < 0.001) were the independent prognostic factors of the PI. Finally, the five variables were combined to construct the nomogram model. The concordance indexes (C-indexes) of the PI were 0.756 (95% CI 0.726–0.786) for the internal validation and 0.729 (95% CI 0.678–0.780) for the external validation. The calibration plots further showed good consistency between the nomogram prediction and the actual observation.Conclusion: This study confirmed that the patients with tumor size 2 cm or smaller were at very low risk for the PI. If other variables such as negative LVSI, DSI <50%, no VI, and negative PLN were limited, the risk would reduce significantly. Meanwhile, a simple nomogram based on the significant clinicopathological characteristics could be used as a tool for the clinicians to predict the PI among the patients with the early-stage CC, who might benefit from a less radical surgery.

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