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

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.

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

2020 ◽  
Vol 30 (9) ◽  
pp. 1317-1325 ◽  
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.

Less radical surgery for early-stage cervical cancer: Can conization specimens help identify patients at low risk for parametrial involvement?

2017 ◽  
Vol 144 (2) ◽  
pp. 290-293 ◽  
Author(s):  
Blair Smith ◽  
Georgia A McCann ◽  
Gary Phillips ◽  
Floor J Backes ◽  
David M O'Malley ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Surgery ◽  
Early Stage ◽  
Low Risk ◽  
Parametrial Involvement ◽  
Early Stage Cervical Cancer

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

Cancers ◽  
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.

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

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.

scholarly journals Management of low-risk early-stage cervical cancer: Should conization, simple trachelectomy, or simple hysterectomy replace radical surgery as the new standard of care?

2014 ◽  
Vol 132 (1) ◽  
pp. 254-259 ◽  
Author(s):  
Pedro T. Ramirez ◽  
Rene Pareja ◽  
Gabriel J. Rendón ◽  
Carlos Millan ◽  
Michael Frumovitz ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Surgery ◽  
Early Stage ◽  
Standard Of Care ◽  
Low Risk ◽  
Early Stage Cervical Cancer

scholarly journals Nomogram Predicting the Likelihood of Parametrial Involvement in Early-Stage Cervical Cancer: Avoiding Unjustified Radical Hysterectomies

2020 ◽  
Vol 9 (7) ◽  
pp. 2121
Author(s):  
Louise Benoit ◽  
Vincent Balaya ◽  
Benedetta Guani ◽  
Arnaud Bresset ◽  
Laurent Magaud ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Surgery ◽  
Early Stage ◽  
Univariate Analysis ◽  
Vascular Involvement ◽  
Metastatic Node ◽  
Predicted Probability ◽  
Parametrial Involvement ◽  
Early Stage Cervical Cancer ◽  
Good Calibration

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.

Nerve Sparing in Radical Surgery for Early-Stage Cervical Cancer: Yes We Should!

2010 ◽  
Vol 20 (Suppl 2) ◽  
pp. S39-S41 ◽  
Author(s):  
Cornelis D. de Kroon ◽  
Katja N. Gaarenstroom ◽  
Mariette I. E. van Poelgeest ◽  
Alexander A. Peters ◽  
J. Baptist Trimbos
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Radical Surgery ◽  
Early Stage ◽  
Surgical Techniques ◽  
Pelvic Lymphadenectomy ◽  
Nerve Sparing ◽  
Autonomic Nerves ◽  
Early Stage Cervical Cancer

Radical hysterectomy with pelvic lymphadenectomy is considered to be the cornerstone in the treatment of early-stage cervical cancer. Although survival in early-stage cervical cancer is up to 95%, long-term morbidity with regard to bladder, bowel, and sexual function is considerable. Damage to the pelvic autonomic nerves may be the cause of these long-term complications following radical hysterectomy. Some authors have presented surgical techniques to preserve the autonomic nerves (ie, the hypogastric nerves and the splanchnic nerves) without compromising radicality. Safety, efficacy, and the surgical techniques of nerve-sparing radical hysterectomy are presented, and data confirm that whenever the decision is made to perform a radical hysterectomy, nerve-sparing techniques should be considered.

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