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

Abstract

Background: The aim of this study was to determine risk factors associated with parametrial involvement (PI) and to identify the subgroup of patients at low risk for PI. Methods: The study comprised 565 patients with early-stage cervical cancer, who underwent radical hysterectomy with pelvic node dissection at Songklanagarind Hospital between 1987 and 2011. Analysis was performed to determine factors associated with PI. Results: Overall, 24 (4.25%) women had PI. PI was more common in patients with non-squamous cell carcinoma, deep stromal invasion (DSI), tumor size > 2 cm, lymphovascular space invasion (LVSI), and pelvic node involvement. Multivariate analysis showed that DSI (p < 0.001) and tumor size > 2 cm (p < 0.001) were independently associated with PI. PI was linked with decreased recurrence-free (p < 0.001) and overall (p = 0.002) survival. Of 347 patients with tumor size ≤ 2 cm and no DSI, only 1 (0.29%) had PI. Conclusion: These findings confirm that PI in early-stage cervical cancer is uncommon. Risk factors associated with PI were DSI and tumor size > 2 cm. PI is a predictor of cervical cancer recurrence and decreased survival. Less radical surgery may be considered in low-risk patients.

Predictive Factors of Pelvic Lymph Node Metastasis in Early-Stage Cervical Cancer

“…In this study, the overall rate of LNM among patients with cervical cancer stages IA2-IB1 was 4.6% (1.9% for stage IA2, and 5.0% for stage IB1), which is similar to that reported by our recent study (4.3%) [6], but considerably lower than most previous studies which reported rates of LNM of 11.6-19.6% [5,7,8]. This difference may be partly explained by noting that most of our patients had relatively small lesions compared to the previous studies which included patients with larger lesions [5,7,8], stages IB2 [7] and IIA [5,7,8] and 1 study which did not include stage IA2 patients [7].…”

“…Therefore, preoperative assessment, such as through ultrasound or magnetic resonance imaging (MRI) looking for the presence of DSI and/or PI, may be needed before definite radical surgery [21,22]. In addition, we have previously reported that the predictive factors associated with PI were DSI and tumor > 2 cm [6. ]Intraoperative clinical evaluation is inadequate for assessing pelvic LNM.…”

“…The definition of DSI was mainly based on the ratio of tumor invading the cervical stroma to more than two-thirds of the cervical thickness. If a cone biopsy was done preoperatively, the maximum depth of stromal invasion was the sum of the depth of the cone biopsy specimen and the depth of the residual tumor [6]. PI was defined as either positive parametrial lymph nodes or malignant cells in the parametrial tissue.…”

“…The incidence of LNM in early-stage cervical cancer is not too high, ranging from 4.3 to 19.6% [5,6,7,8]. In addition, whether or not there are therapeutic benefits from pelvic lymphadenectomy in patients with early-stage cervical cancer is still controversial [2,9,10].…”

Prevalence and Distribution of High-Risk Human Papillomavirus Genotypes in Invasive Carcinoma of the Uterine Cervix in Uruguay. An update on clinical outcome

“…Although histological types have been suggested as independent prognostic factors (Mabuchi, 2012;, no significant differences in OS were found in our population. In agreement with Bradbury et al we found significant correlation of OS with lymph node metastasis but not extrauterine invasion (Table III) (Bradbury, 2015), although other authors reported significant correlation of parametrial involvement with disease-free and overall survival (Jiamset, 2016 (Mao, 2016). Current literature suggests that patients with low-risk early-stage CC may be candidates for more conservative approaches, preserving reproductive function (Baiocchi, 2017;Willows, 2016).…”