What Are The Determinants of Parametrial Invasion In Patients With Early Stage Cervical Cancer: A Cross Sectional Study

Abstract Background: There was an increase in number of patients presented with early-stage cervical cancer (CC). Tumors with favorable pathological features might be candidates for less radical surgery.Methods: We retrospectively reviewed 700 patients with histologically confirmed CC between January 2011 and March 2020. Chi-square, Fisher's exact tests and multivariate logistic regression analysis were used to assess relations between parametrial involvement (PI) and clinic-pathological variables.Results: Total number of 132 patients with stage IA to IIA were eligible to participate. Squamous cell carcinoma was reported in 100 (75.8%) patients, adenocarcinoma and other tumor pathologies were found in 24(18.2%) and 8(6.1%), respectively. Considering the FIGO stage, 11 (8.4%) patients had IA, 111 (83%%) IB and 10 (7.6%) IIA. Nine patients (6.8%) had PI on permanent pathologic report. Univariate analysis demonstrated that following variables were statistically different between patients with and without PI: age ≥ 50, tumor size ≥ 3cm, lower segment involvement, poorly differentiated pathology, deep stromal invasion, pelvic lymph node, lympho-vascular involvement and positive surgical margin (all p values < 0.05). Among these variables only tumor size ≥ 3 cm (OR: 2.1, 95% CI: 1.11-4.16, p value: 0.02), deep stromal invasion (OR: 2.2, 95% CI: 1.9-7.43, p value: 0.02) and positive surgical margin (OR: 5.1, 95% CI: 3.97-11.15, p value: 0.008) were independent risk factor of PI in multivariate analysis.Conclusions: Early stage CC can be surgically approached in a more conservative manner if patients have tumor size < 3 cm and do not have deep stromal invasion in conization.

Download Full-text

The Clinical Impact of Low-Volume Lymph Nodal Metastases in Early-Stage Cervical Cancer: The Senticol 1 and Senticol 2 Trials

Cancers ◽

10.3390/cancers12051061 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1061 ◽

Cited By ~ 6

Author(s):

Benedetta Guani ◽

Vincent Balaya ◽

Laurent Magaud ◽

Fabrice Lecuru ◽

Patrice Mathevet

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Early Stage ◽

Univariate Analysis ◽

Disease Free Survival ◽

Stromal Invasion ◽

Factors Associated ◽

Specificity And Sensitivity ◽

Early Stage Cervical Cancer ◽

Low Volume

Background: With the development of the sentinel node technique in early-stage cervical cancer, it is imperative to define the clinical significance of micrometastases (MICs) and isolated tumor cells (ITCs). Methods: We included all patients who participated in the Senticol 1 and Senticol 2 studies. We analyzed the factors associated with the presence of low-volume metastasis, the oncological outcomes of patients with MIC and ITC and the correlation of recurrences and risk factors. Results: Twenty-four patients (7.5%) had low-volume metastasis. The risk factors associated with the presence of low-volume metastasis were a higher stage (p = 0.02) and major stromal invasion (p = 0.01) in the univariate analysis. The maximum specificity and sensitivity were found at a cutoff of 8 mm of stromal invasion. In multivariate analysis, the higher stage (p = 0.02) and the positive lymphovascular space invasion (p = 0.02) were significantly associated with the MIC and ITC. Patients with low-volume metastasis had similar disease-free survival (DFS) (92.7%) to node-negative patients (93.6%). The addition of adjuvant treatment in presence of low-volume metastasis did not modify the DFS. Conclusions: These results confirm our previous analysis of Senticol 1: the presence of low-volume metastasis did not decrease the DFS in early-stage cervical cancer patients.

Download Full-text

Risk Factors for Recurrence after Robot-Assisted Radical Hysterectomy for Early-Stage Cervical Cancer: A Multicenter Retrospective Study

Cancers ◽

10.3390/cancers12113387 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3387

Author(s):

Jordi Ponce ◽

Sergi Fernandez-Gonzalez ◽

Antonio Gil-Moreno ◽

Pluvio J. Coronado ◽

Jesús De la Rosa ◽

...

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Radical Hysterectomy ◽

Tumor Size ◽

Early Stage ◽

Tumor Grade ◽

Robot Assisted ◽

Invasive Approach ◽

Early Stage Cervical Cancer ◽

Risk Factors For Recurrence

This retrospective analysis aimed to assess the risk factors for recurrence in patients diagnosed with early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009) undergoing robot-assisted radical hysterectomy in Spain and Portugal between 2009 and 2018. A second primary objective was to audit the oncological outcomes according to quality indicators (QI) proposed by the European Society of Gynecology Oncology (ESGO). The study population included 239 women. After a median follow-up of 51 months, recurrence occurred in 26 patients (10.9%). Independent factors for recurrence were clinical tumor size > 20 mm (hazard ratio (HR) 2.37), adenocarcinoma as histological type (HR 2.51), positive pelvic lymph nodes (HR 4.83), tumor grade 2 (HR 4.99), tumor grade 3 (HR 8.06), and having not performed sentinel lymph node biopsy (SLNB) (HR 4.08). All 5 QI selected were surpassed by our results. In patients with early-stage cervical cancer undergoing robotic radical hysterectomy, clinicians should be aware that tumor grade 2 and 3, tumor size > 20 mm, adenocarcinoma, positive pelvic nodes, and lack of performance of SLNB are risk factors for recurrence. Fulfillment of QI targets of the ESGO might be considered as an objective oncological outcome indicator supporting the minimally invasive approach for early-stage cervical cancer treatment.

Download Full-text

Outcomes of pre-operative brachytherapy followed by hysterectomy for early cervical cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000617 ◽

2019 ◽

Vol 30 (2) ◽

pp. 181-186 ◽

Cited By ~ 1

Author(s):

Benoit Bataille ◽

Alexandre Escande ◽

Florence Le Tinier ◽

Audrey Parent ◽

Emilie Bogart ◽

...

Keyword(s):

Cervical Cancer ◽

Tumor Size ◽

Early Stage ◽

Disease Free Survival ◽

Late Toxicity ◽

Free Survival ◽

Overweight Status ◽

Early Stage Cervical Cancer ◽

Early Cervical Cancer ◽

Disease Free

ObjectiveThe standard of care for early cervical cancer is radical hysterectomy; however, consideration of pre-operative brachytherapy has been explored. We report our experience using pre-operative brachytherapy plus Wertheim-type hysterectomy to treat early stage cervical cancer.MethodsThis single-center study evaluated consecutive patients with histologically proven node-negative early stage cervical cancer (International Federation of Gynecology and Obstetrics 2009 stage IB1–IIB) that was treated using pre-operative brachytherapy and hysterectomy. Pre-brachytherapy staging was performed using magnetic resonance imaging (MRI) and pelvic lymph node assessment was performed using lymphadenectomy. The tumor and cervical tissues were treated using brachytherapy (total dose 60 Gy) followed by Wertheim-type hysterectomy. The study included patients from January 2000 to December 2013.ResultsA total of 80 patients completed a median follow-up of 6.7 years (range 5.4–8.5). The surgical specimens revealed a pathological complete response for 61 patients (76%). Patients with incomplete responses generally had less than 1 cm residual tumor at the cervix, and only one patient had lymphovascular space involvement. The estimated 5-year rates were 88% for overall survival (95% CI 78% to 94%) and 82% for disease-free survival (95% CI 71% to 89%). Toxicities were generally mild-to-moderate, including 26 cases (33%) of grade 2 late toxicity and 10 cases (13%) of grade 3 late toxicity. Univariate analyses revealed that poor disease-free survival was associated with overweight status (≥25 kg/m2, HR 3.05, 95% CI 1.20 to 7.76, p=0.019) and MRI tumor size >3 cm (HR 3.05, 95% CI 1.23 to 7.51, p=0.016).ConclusionsPre-operative brachytherapy followed by Wertheim-type hysterectomy may be safe and effective for early stage cervical cancer, although poorer outcomes were associated with overweight status and MRI tumor size >3 cm.

Download Full-text

Should the Number of Metastatic Pelvic Lymph Nodes Be Integrated into the 2018 Figo Staging Classification of Early Stage Cervical Cancer?

Cancers ◽

10.3390/cancers12061552 ◽

2020 ◽

Vol 12 (6) ◽

pp. 1552

Author(s):

Luigi Pedone Anchora ◽

Vittoria Carbone ◽

Valerio Gallotta ◽

Francesco Fanfani ◽

Francesco Cosentino ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Nodes ◽

Early Stage ◽

Disease Free Survival ◽

Staging System ◽

Lymph Node Status ◽

P Value ◽

Pelvic Lymph Nodes ◽

Early Stage Cervical Cancer ◽

The Impact

Introduction: Lymph node status has become part of the new staging system for cervical cancer (CC). It has been shown that patients staged as IIIC1 had heterogeneous prognoses and, in some cases, experienced better outcomes than patients with lower stages. We evaluated the impact of the number of metastatic pelvic lymph nodes (MPLNs) among patients with stage IIIC1 cervical cancer. Methods: Survival analyses were conducted in order to identify the best cut-off prognostic value relative to the number of MPLNs. Disease free survival (DFS) was considered the main outcome. Results: 541 patients were included in the study. Eighty-nine patients were of stage IIIC1. The best prognostic cut-off value of the number of MPLNs was 2. Patients with >2 MPLNs (n > 2 group) had worse DFS compared with those having <2 (N1-2 group) (5 yr DFS: 54.7% vs. 78.1%, p value = 0.006). Multivariate analyses demonstrated that the extent of MPLNs had little impact on DFS and that replacement of IIIC1 staging with N1-2 and n > 2 grouping provided a better, statistically significant model (p value = 0.006). Discussion: Using a cut-off value of 2, the number of MPLNs could better predict prognostic outcomes within stage IIIC1 cervical cancer and have potential implications for therapeutic decision-making in the treatment of patients with stage IIIC1 CC.

Download Full-text

Postoperative radiotherapy of cervival carcinoma: Treatment results and analysis of prognostic factors

Acta chirurgica iugoslavica ◽

10.2298/aci0904195p ◽

2009 ◽

Vol 56 (4) ◽

pp. 195-200

Author(s):

V. Plesinac-Karapandzic ◽

N. Borojevic ◽

Z. Milosevic ◽

B. Markovic ◽

M. Nikitovic ◽

...

Keyword(s):

Cervical Cancer ◽

Prognostic Factors ◽

Lymph Nodes ◽

Cancer Patients ◽

Early Stage ◽

Postoperative Radiotherapy ◽

Surgical Margin ◽

Disease Free Survival ◽

Residual Tumor ◽

Positive Surgical Margin

The purpose of the study was to evaluate the efficacy of postoperative radiotherapy (RT) and to investigate prognostic factors for early-stage cervical cancer patients. We reviewed the medical records of 162 cervical cancer patients treated by RT during 2003 year. RT included 30- 45Gy of external photons to pelvis in 12-25 fractions. Brachytherapy with 192Ir was delivered in 3-5 fractions to a dose of 27-32 Gy. The mean age was 49 years (range 27-71). Majority of patients 130 had Stage Ib. Radical hysterectomy with lymphadenectomy was performed in 122pts. and simple hysterectomy in 40 pts. The 5-year actuarial overall survival (OS) for all patients was 92,6% and disease-free survival (DFS) was 90,9%.There was statistically significant differences in OS and DFS in pat. with positive vs. negative pelvic lymph nodes; tumor 4cm vs. tumor <4cm; positive vs. negative surgical margin/residual tumor (p<0,05). Late GIT complications were determined in 35,8% and UT in 12,3%. In conclusion, postoperative radiotherapy has achieved high-satisfactory survival with acceptable complications. The survival benefit was less evident among patients with positive lymph nodes, tumor > 4cm and positive surgical margin/ residual tumor.

Download Full-text

Comparison of laparoscopic versus open radical hysterectomy in patients with early-stage cervical cancer: a multicenter study in China

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001340 ◽

2020 ◽

Vol 30 (8) ◽

pp. 1143-1150

Author(s):

Ting wen yi Hu ◽

Yue Huang ◽

Na Li ◽

Dan Nie ◽

Zhengyu Li

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Radical Hysterectomy ◽

Tumor Size ◽

Early Stage ◽

Disease Free Survival ◽

Free Survival ◽

Laparoscopic Radical Hysterectomy ◽

Early Stage Cervical Cancer ◽

Disease Free

IntroductionRecently, the safety of minimally invasive surgery in the treatment of cervical cancer has been questioned. This study was designed to compare the disease-free survival and overall survival of abdominal radical hysterectomy and laparoscopic radical hysterectomy in patients with early-stage cervical cancer.MethodsA total of 1065 patients with early-stage cervical cancer who had undergone abdominal/laparoscopic radical hysterectomy between January 2013 and December 2016 in seven hospitals were retrospectively analyzed. The 1:1 propensity score matching was performed in all patients. Patients with tumor size ≥2 cm and <2 cm were stratified and analyzed separately. Disease-free survival and overall survival were compared between matched groups. After conﬁrming the normality by the Shapiro-Wilks test, the Mann-Whitney U test and the χ2 test were used for the comparison of continuous and categorical variables, respectively. The survival curves were generated by the Kaplan-Meier method and compared by log-rank test.ResultsAfter matching, a total of 812 patients were included in the disease-free survival and overall survival analyses. In the entire cohort, the laparoscopic radical hysterectomy group had a significantly shorter disease-free survival (HR 1.65, 95% CI 1.00 to 2.73; p=0.048) but not overall survival (HR 1.60, 95% CI 0.89 to 2.88; p=0.12) when compared with the abdominal radical hysterectomy group. In patients with tumor size ≥2 cm, the laparoscopic radical hysterectomy group had a significantly shorter disease-free survival (HR 1.93, 95% CI 1.05 to 3.55; p=0.032) than the abdominal radical hysterectomy group, whereas no significant difference in overall survival (HR 1.90, 95% CI 0.95 to 3.83; p=0.10) was found. Additionally, in patients with tumor size <2 cm, the laparoscopic radical hysterectomy and abdominal radical hysterectomy groups had similar disease-free survival (HR 0.71, 95% CI 0.24 to 2.16; p=0.59) and overall survival (HR 0.59, 95% CI 0.11 to 3.13; p=0.53).ConclusionLaparoscopic radical hysterectomy was associated with inferior disease-free survival compared with abdominal radical hysterectomy in the entire cohort, as well as in patients with tumor size ≥2 cm. For the surgical treatment of patients with early-stage cervical cancer, priority should be given to open abdominal radical hysterectomy.

Download Full-text