Pretreatment risk factors for parametrial involvement in FIGO stage IB1 cervical cancer

5526 Background: The cornerstone of the management of cervical cancer (CC) traditionally relies on clinical examination assessment (CE) of tumor size (TS) and local extension of disease. Previous reports demonstrate poor accuracy of CE, with the most common discrepancy being failure to identify parametrial involvement (PI). The goal of this study is to determine the accuracy of CE in comparison to final pathology (FP) in early operable CC. Methods: This is a multi-center retrospective review of patients with early CC (FIGO stage IB1, IIA1). Data on age, race, histology, stage, CE findings, FP report and receipt of adjuvant radiation therapy (RT) were collected. CE findings included TS, PI and vaginal involvement (VI). CE of TS, PI, and VI were compared to FP. Subanalysis was also conducted based on TS ( < or ≥ 2cm) and location of tumor (exophytic vs endophytic). Analysis was performed using paired-T and Cohen’s Kappa tests. Results: Final analysis included 135 patients. Mean age was 52.6 years. The majority of patients had squamous cell carcinoma (72.6%). Overall, there was a significant difference between CE of TS compared to FP; mean error of 1.22 cm (p < 0.0001). In those with tumors ≥ 2cm the mean error was 1.28 cm (p < 0.0001). No significant discrepancy was observed in tumors < 2 cm (mean error: 1.10cm; p = 0.5). CE of TS of endophytic tumors was poor (mean error 1.68cm; p = 0.004) compared to exophytic tumors (mean error: 1.12 cm; p = 0.693). There was no significant difference in the identification of VI between CE and FP (3.7% vs 8.89%; p = 0.067). No patients with PI on CE were included in this analysis. However, 14.07% of patients were found to have PI on FP (p < 0.0001). There was no difference in the accuracy CE of TS between non-obese ( < 30 kg/m2) and obese patients (≥30 kg/m2), mean error 1.13 and 1.3, respectively (p = 0.061). As a results of FP, 55 patients (40.7%) received adjuvant RT and 38 patients (28.14%) were upstaged from IB1 to IB2. Of these 38 patients, 36 (94.7%) went on to receive adjuvant RT. Conclusions: CE of TS and PI is inaccurate, especially in tumors ≥ 2cm and endophytic tumors. This suggests imaging should be strongly encouraged, particularly in the setting of the updated FIGO 2018 staging system and recent debate over surgical approach.

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Analysis of the effect of adjuvant radiotherapy on outcomes and complications after radical hysterectomy in FIGO stage IB1 cervical cancer patients with intermediate risk factors (GOTIC Study)

World Journal of Surgical Oncology ◽

10.1186/s12957-016-0931-4 ◽

2016 ◽

Vol 14 (1) ◽

Cited By ~ 11

Author(s):

Kazuto Nakamura ◽

Yoshikazu Kitahara ◽

Toyomi Satoh ◽

Yuji Takei ◽

Masashi Takano ◽

...

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Cancer Patients ◽

Radical Hysterectomy ◽

Adjuvant Radiotherapy ◽

Figo Stage ◽

Intermediate Risk

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Prognostic Factors Associated with 5-Year Overall Survival in Cervical Cancer Patients Treated with Radical Hysterectomy Followed by Adjuvant Concurrent Chemoradiation Therapy at a Tertiary Care Center in Eastern Europe

Diagnostics ◽

10.3390/diagnostics11030570 ◽

2021 ◽

Vol 11 (3) ◽

pp. 570

Author(s):

Mihai Stanca ◽

Mihai Emil Căpîlna

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Overall Survival ◽

Radical Hysterectomy ◽

Care Center ◽

Tertiary Care ◽

Figo Stage ◽

Chemoradiation Therapy ◽

Prognostic Risk Factors ◽

Concurrent Chemoradiation Therapy

Background: This retrospective observational study aims to assess the 5-year overall survival and the prognostic significance of risk factors of patients who underwent radical hysterectomy followed by adjuvant concurrent chemoradiation therapy (CCRT) for FIGO stage IB1-IIB cervical cancer in a tertiary care center in Eastern Europe. Methods: From January 2010 to February 2019, 222 patients with stage IB1-IIB cervical cancer were treated with radical hysterectomy followed by adjuvant CCRT in our institution. The baseline information consisting of demographic and clinicopathologic data, treatment choices, recurrences, and outcome information was collected and examined. The survival rates were illustrated using Kaplan–Meier curves and prognosis analyses were accomplished using Cox multivariate analyses. Results: The 222 participants had a mean age of 51.2 years (28–76). The median follow-up time was 65.5 months (3–128). Tumor characteristics revealed FIGO stage (IB1 2.3%, IB2 35.1%, IB3 16.7%, IIA1 9%, IIA2 8.6%, IIB 28.4%) and the most encountered histologic cell type was squamous cell carcinoma (80.06%) followed by adenocarcinoma (11.3%). At the time of examination, 157 patients (70.07%) were alive, of which 135 (61%) were alive free of disease and 22 (9%) were alive with disease. The multivariate Cox regression analysis acknowledged stage IIB, parametrial involvement, and the presence of lymph node metastases as independent prognostic risk factors, significantly worsening the oncologic outcomes influencing the survival with a P-value of 0.076, 0.0001, and 0.008, respectively. The 5-year overall survival was 69.9%. Conclusions: Altogether, the study enhances the significance of prognostic risk factors on the 5-year overall survival of patients who underwent radical hysterectomy followed by adjuvant CCRT for FIGO stages IB1-IIB cervical cancer, allowing comparisons with other regions.

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Nomogram prediction for overall survival of patients diagnosed with cervical cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.5111 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 5111-5111

Author(s):

Christoph Grimm ◽

Alexander Reinthaller ◽

Gerda Hofstetter ◽

Nicole Concin ◽

Christian Marth ◽

...

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Figo Stage ◽

Bootstrap Sample ◽

Histologic Subtype ◽

Prognostic Parameter ◽

Correction Technique ◽

Parametrial Involvement ◽

Node Ratio ◽

Stage Ia

5111 Background: Cervical cancer is clinically staged based upon the International Federation of Gynecologists and Obstetricians (FIGO) system. FIGO stage is well established as prognostic parameter. It is well known that other additional parameters are useful to estimate overall survival (OS) in patients with cervical cancer. The aim of this multi-center was to create a nomogram to predict OS in patients diagnosed with cervical cancer. Methods: Cervical cancer databases of two large Austrian institutions were analysed. Characteristics known to predict OS were collected. For each patient association between each prognostic parameter and OS was assessed by multivariable modeling. The corresponding 3-year and 5-year OS probabilities were then determined using the nomogram. The constructed nomogram was then validated using the bootstrap correction technique. Results: Mean 5-year OS rates for patients with FIGO stage IA, IB, II, III, and IV were 99.0% (1.0), 88.6% (3.0), 65.8% (5.2), 58.7% (11.0), and 41.5% (14.7), respectively (p<0.001). Mean five-year OS time was 44.2 (30.9) months. Based on the multivariable model FIGO stage, tumor size, age, histologic subtype, lymph node ratio, and parametrial involvement were identified as nomogram parameters. The bootstrap sample corrections provided an estimated concordance probability (interquartile range) of 0.794 (0.779-0.805). Conclusions: Based on 6 easily available parameters a novel nomogram to predict 3-year and 5-year OS of patients diagnosed with cervical cancer was constructed and internally validated. Application of this nomogram allows more accurate and individual prediction of patients’ prognosis.

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Risk Factors of Pelvic Lymph Node Metastasis and Recurrence in Patients with Early Cervical Cancer

10.21203/rs.3.rs-1041771/v1 ◽

2021 ◽

Author(s):

Xinmei Wang ◽

Hongyuan Zhang ◽

Juan Xu ◽

Pengpeng Qu

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Lymph Node ◽

Figo Stage ◽

Pelvic Lymphadenectomy ◽

Pelvic Lymph Node ◽

Tumor Diameter ◽

Preoperative Hemoglobin ◽

Node Metastasis ◽

Pelvic Lymph Node Metastasis

Abstract Background: Pelvic lymph node metastasis (PLNM) is one of the critical factors affecting the postoperative prognosis of patients with cervical cancer. Preoperative identification of risk factors for PLNM can optimize preoperative treatment plans and prognostic assessments.The purpose of this study was to investigate the risk factors for PLNM and its recurrence in patients undergoing radical hysterectomy for cervical cancer.Methods: Medical records of 245 patients who underwent radical hysterectomy and bilateral pelvic lymphadenectomy as primary treatment for the International Federation of Gynaecology and Obstetrics (FIGO,2009) stage IA-IIA cervical cancer between January 2010 and December 2015 were reviewed. Clinicopathological risk factors were retrospectively analyzed. All patients were followed up for 5–10 years. Multivariate analysis was performed using a logistic regression model for the analysis of risk factors for PLNM.Results: Preoperative hemoglobin level, FIGO stage, LVSI, parametrial infiltration, and tumor diameter differed significantly between the two groups (P<0.05).Multivariate analysis revealed preoperative hemoglobin <110 g/L, FIGO stage II, LVSI, parametrial infiltration, and tumor diameter ≥4 cm as significant risk factors for PLNM and recurrence of cervical cancer after surgery (P<0.05). PLNM was identified as the independent risk factor for recurrence in patients with cervical cancer after surgery (P<0.05).Conclusions: Patients with PLNM have a high recurrence rate, and postoperative follow-up should be closely followed to ensure timely detection of recurrence and treatment. For patients at high risk of PLNM, intraoperative careful and comprehensive pelvic lymph node resection should be performed to avoid missing metastatic lymph nodes and affecting the prognosis. Given the many complications of pelvic lymph node dissection for the low-risk population, further research is needed to determine whether pelvic lymphadenectomy should be attempted only in high-risk individuals.

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