Evaluation of Clinical and Pathologic Risk Factors May Reduce the Rate of Multimodality Treatment of Early Cervical Cancer

Gemer, Ofer; Lavie, Ofer; Gdalevich, Michael; Eitan, Ram; Mamanov, Ela; Piura, Benjamin; Rabinovich, Alex; Levavi, Hanoch; Saar-Ryss, Bozhena; Halperin, Reuvit; Finci, Shachar; Beller, U.; Bruchim, Ilan; Levy, Tally; Meirovitz, Amichay; Shachar, Inbar Ben; Arie, Alon Ben

doi:10.1097/coc.0000000000000011

Cited by 12 publications

(13 citation statements)

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“…Recent literature, especially with the advent of more and more fertility sparing surgery suggests tumor size more than 2 cm is a risk factor. [82][83][84][85][86][87][88][89][90][91] . In a recent study, Gemer et al 91…”

Section: It Was Incorporated In the Figo Staging System As Stage Ib2mentioning

confidence: 99%

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Cancer of the cervix uteri

Bhatla

Aoki

Sharma

et al. 2018

Intl J Gynecology & Obste

954

799

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Since the publication of the last FIGO Cancer Report there have been giant strides in the global effort to reduce the burden of cervical cancer, with WHO announcing a call for elimination. In over 80 countries, including LMICs, HPV vaccination is now included in the national program. Screening has also seen major advances with implementation of HPV testing on a larger scale. However, these interventions will take a few years to show their impact. Meanwhile, over half a million new cases are added each year. Recent developments in imaging and increased use of minimally invasive surgery have changed the paradigm for management of these cases. The FIGO Gynecologic Oncology Committee has revised the staging system based on these advances. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality of life issues.

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Section: It Was Incorporated In the Figo Staging System As Stage Ib2mentioning

confidence: 99%

“…Since 2009 it was incorporated in the FIGO staging system as Stage IB2 and now in the 2018 staging revision as Stage IB3. Recent literature, especially with the advent of more and more fertility sparing surgery suggests tumor size more than 2 cm is a risk factor …”

Section: Management Of Cervical Cancermentioning

confidence: 99%

Cancer of the cervix uteri

Bhatla

Aoki

Sharma

et al. 2018

Intl J Gynecology & Obste

954

799

View full text Add to dashboard Cite

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“…This inconsistence could be explained by the disparity in the nomenclature of lymph node groups; the lymph nodes caudal to the deep circumflex iliac vessels were included in the external iliac in our study. Among the known risk factors of LNM in patients with early stage cervical cancer, tumour size and LVSI are assessable before surgery through imaging and histological evaluation of specimens of conisation, loop electrical excision procedure, and cervical biopsy, respectively [26,27]. Interestingly, in the present study, LVSI was identified as an independently predictive for metastasis in all three lower groups of pelvic lymph nodes but not in common iliac LNM; on the contrary, tumour size was a robust predictor for common iliac LNM but not significantly associated with lower pelvic node metastasis.…”

Section: Discussionmentioning

confidence: 99%

Region-specific Risk Factors for Pelvic Lymph Node Metastasis in Patients with Stage IB1 Cervical Cancer

Zhao¹,

Cai²,

Wang³

et al. 2021

J. Cancer

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Objectives: We aimed to identify the risk factors associated with pelvic lymph node metastasis (LNM) at each anatomic location in patients with stage IB1 cervical cancer. Methods: A primary cohort of 728 patients with stage IB1 cervical cancer who underwent radical hysterectomy and systematic pelvic lymphadenectomy were retrospectively studied. All removed pelvic nodes (N=20,134) were pathologically examined. The risk factors for LNM in different anatomic regions (obturator, internal iliac, external iliac, and common iliac) were evaluated by multivariate logistic regression analyses. Nomograms were generated from the primary cohort and validated in another external cohort (N=242). The performance of the nomogram was assessed by its calibration and discrimination. Overall survival and progression-free survival in patients with different LNM patterns were compared. Results: LNM was found in 266 (1.3%) removed nodes and 106 (14.6%) patients. The incidences of LNM at the obturator, internal iliac, external iliac, common iliac, and parametrial regions were 8.5%, 5.4%, 4.7%, 1.9% and 1.8%, respectively. Among others, tumour size and lymph-vascular space invasion (LVSI), which are preoperatively assessable, were identified as independent risk factors of LNM in the common iliac region and the lower pelvis, respectively, and age was an additional independent risk factor of obturator LNM. The negative predictive values of tumour size <2 cm for common iliac LNM and negative LVSI combined with older age (> 50 years) for obturator LNM were 100% and 98.7%, respectively. A nomogram of these two factors showed good calibration and discrimination (concordance index, 0.761 in the primary cohort and 0.830 in validation cohort). The patients with common iliac LNM had poorer survival than those with LNM confined to the lower pelvis, while the differences in survival between patients with LNM confined to one node, one region or single side and those with more widely spreading LNM were not statistically significant. Conclusions: Tumour size, LVSI and age are region-specific risk factors for pelvic LNM in IB1 cervical cancer, which could be used to allocate the appropriate extent of pelvic lymphadenectomy.

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“…[6] Patients with pathological risk factors (e.g., LNM, tumor-positive surgical margins, depth of invasion, vascular thrombosis, interstitial infiltration depth, tumor stage, and tumor differentiation) have a higher frequency of recurrence when compared to patients without those factors. [7] At the same time, especially recent studies have found that the size of tumors over 2 cm may also be a poor prognostic factor, [8–12] which has a certain correlation with the depth of invasion of tumors. Hence, it is vital to analyze the influence of different risk factors on the prognosis of patients with early-stage cervical cancer, which also decides how to plan adjuvant treatment after surgery.…”

Section: Introductionmentioning

confidence: 99%