Risk of Parametrial Spread in Small Stage I Cervical Carcinoma

Vranes, Boris; Milenković, S.; Radojević, Miloš; Soldatović, Ivan; Kesić, Vesna

doi:10.1097/igc.0000000000000604

Cited by 16 publications

(4 citation statements)

References 32 publications

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“…Factors found to be associated with PMI included large tumor size, pelvic node metastasis, LVSI, deep cervical stromal invasion, histology, high tumor grade, uterine metastasis, and vaginal involvement. A subset of patients at very low risk for PMI (risk < 1%) were identified with various combinations of tumor sizes smaller than 2 cm, negative pelvic nodes, negative LVSI, and no more than inner third cervical stromal invasion [6,[48][49][50][51][52]. However, apart from the tumor size, other factors incorporated in the proposed combinations could not be reliably determined before surgery.…”

Section: Discussionmentioning

confidence: 99%

iPMI: Machine Learning-Aided Identification of Parametrial Invasion in Women with Early-Stage Cervical Cancer

et al. 2021

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Radical hysterectomy is a recommended treatment for early-stage cervical cancer. However, the procedure is associated with significant morbidities resulting from the removal of the parametrium. Parametrial cancer invasion (PMI) is found in a minority of patients but the efficient system used to predict it is lacking. In this study, we develop a novel machine learning (ML)-based predictive model based on a random forest model (called iPMI) for the practical identification of PMI in women. Data of 1112 stage IA-IIA cervical cancer patients who underwent primary surgery were collected and considered as the training dataset, while data from an independent cohort of 116 consecutive patients were used as the independent test dataset. Based on these datasets, iPMI-Econ was then developed by using basic clinicopathological data available prior to surgery, while iPMI-Power was also introduced by adding pelvic node metastasis and uterine corpus invasion to the iPMI-Econ. Both 10-fold cross-validations and independent test results showed that iPMI-Power outperformed other well-known ML classifiers (e.g., logistic regression, decision tree, k-nearest neighbor, multi-layer perceptron, naive Bayes, support vector machine, and extreme gradient boosting). Upon comparison, it was found that iPMI-Power was effective and had a superior performance to other well-known ML classifiers in predicting PMI. It is anticipated that the proposed iPMI may serve as a cost-effective and rapid approach to guide important clinical decision-making.

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Section: Discussionmentioning

confidence: 99%

iPMI: Machine Learning-Aided Identification of Parametrial Invasion in Women with Early-Stage Cervical Cancer

et al. 2021

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“…The primary objective of employing SH treatment for early-stage cervical cancer patients is to accurately stratify patients based on the presence or absence of parametrial invasion risk prior to surgical intervention. Patients with favorable pathological features are associated with a notably low incidence of parametrial invasion, eliminating the need for complete removal of the parametrial area (33)(34)(35). A significant update in the latest NCCN guidelines (36) pertains to the management of low-risk patients with IA2-IB1 stage cervical cancer following cone biopsy.…”

Section: How To Screen Suitable Patients For Shmentioning

confidence: 99%

Efficacy and safety analysis of non-radical surgery for early-stage cervical cancer (IA2 ~ IB1): a systematic review and meta-analysis

Zeng,

Xiao,

et al. 2024

Front. Med.

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ObjectiveRadical hysterectomy has long been considered as the standard surgical treatment for early-stage cervical cancer (IA2 to IB1 stages), according to the 2009 International Federation of Obstetrics and Gynecology. This study aims to conduct an in-depth evaluation of the effectiveness and safety of non-radical surgery as an alternative treatment for patients with early-stage cervical cancer.MethodsA systematic search of online databases including PubMed, Embase, and the Cochrane Library was conducted to identify relevant literature on surgical treatment options for early-stage cervical cancer. Keywords such as “cervical cancer,” “conservative surgery,” “early-stage,” “less radical surgery,” and “simple hysterectomy” were used. Meta-analysis was performed using Stata 15.0 software, which included randomized controlled trials (RCTs) and cohort studies.ResultsThis meta-analysis included 8 eligible articles covering 9 studies, with 3,950 patients in the simple hysterectomy (SH) surgery group and 6,271 patients in the radical hysterectomy (RH) surgery group. The results indicate that there was no significant difference between the two groups in terms of the Overall Survival (OS) (HR = 1.04, 95% CI: 0.86–1.27, p = 0.671; Heterogeneity: I2 = 33.8%, p = 0.170), Disease Free Survival (DFS) (HR = 1.39, 95% CI: 0.59–3.29, p = 0.456; Heterogeneity: I2 = 0.0%, p = 0.374), Cervical Cancer Specific Survival (CCSS) (HR = 1.11, 95% CI: 0.80–1.54, p = 0.519; Heterogeneity: I2 = 11.9%, p = 0.287) and recurrence rate (RR = 1.16, 95% CI: 0.69–1.97, p = 0.583; Heterogeneity: I = 0.0%, p = 0.488). However, the mortality rate (RR = 1.35, 95% CI: 1.10–1.67, p = 0.006; Heterogeneity: I2 = 35.4%, p = 0.158) and the rate of postoperative adjuvant therapy (RR = 1.59, 95% CI: 1.16–2.19, p = 0.004; Heterogeneity: I2 = 92.7%, p < 0.10) were higher in the SH group compared to those in the RH group. On the other hand, the incidence of surgical complications was lower in the SH group (RR = 0.36, 95% CI: 0.21–0.59, p = 0.004; Heterogeneity: I2 = 0.0%, p = 0.857) than that in the RH group. Subgroup analysis revealed that patients in the IB1 stage SH group had a significantly higher mortality rate compared to those in the RH group (RR = 1.59, 95% CI: 1.23–2.07, p < 0.001; Heterogeneity: I2 = 0.0%, p = 0.332). However, there was no significant difference in mortality rates between the two groups for patients at stage IA2 (RR = 0.84, 95% CI: 0.54–1.30, p = 0.428; Heterogeneity: I2 = 26.8%, p = 0.243). In the subgroups positive for Lymphovascular Space Invasion (LVSI), patients in the SH group had a significantly higher mortality rate than those in the RH group (RR = 1.34, 95% CI: 1.09–1.65, p = 0.005; Heterogeneity: I2 = 41.6%, p = 0.128). However, in the LVSI-negative subgroups, there was no significant difference in mortality rates between the two groups (RR = 0.33, 95% CI: 0.01–8.04, p = 0.499).ConclusionFor patients with early-stage cervical cancer patients at IA2 without LVSI involvement, comparisons between the two groups in terms of OS, DFS, CCSS, recurrence rate, and mortality rates revealed no statistically significant differences, indicating that the choice of surgical approach does not affect long-term survival outcomes for this specific patient group. For patients at IB1 and IA2 stages with LVSI involvement, while there were no significant differences between the two groups in OS, DFS, CSS, and recurrence rate, a significant increase in mortality rates was observed in the SH group. This indicates a potential elevated risk of mortality associated with SH in this subset of patients. Notably, the incidence of surgical complications was significantly lower in the SH group compared to the RH group, highlighting the safety profile of SH in this context. Significantly, among patients in the SH group, an increase in the rate of postoperative adjuvant treatment is associated with a higher occurrence of treatment-related complications. To facilitate more precise patient selection for conservative surgical management, future prospective studies of superior quality are imperative to gain deeper insights into this matter.Systematic review registrationPROSPERO (CRD42023451609: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023451609).

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“…[11][12][13] Many studies have shown that the risk of parametrial metastases in select patients with early-stage cervical cancer is fairly low. Patients with a small volume of tumor, without lymphovascular space invasion (LVSI) and regional lymph node involvement, have been thought to have less than 1% possibility of parametrial invasion, [14][15][16] indicating that perhaps those patients could have been overtreated with radical hysterectomy. Also, several studies have demonstrated that simple trachelectomy plus pelvic lymphadenectomy is safe and feasible for low-risk early-stage cervical cancer patients who desire future fertility.…”

Section: Introductionmentioning

confidence: 99%

Simple Hysterectomy for Patients with Stage IA2 Cervical Cancer: A Retrospective Cohort Study

Liu¹,

Xu²,

He³

et al. 2021

CMAR

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Objective:The purpose of this study was to compare long-term survival outcomes of simple hysterectomy versus radical hysterectomy in stage IA2 cervical cancer. Methods: A total of 440 patients who underwent simple hysterectomy (SH group) or radical hysterectomy (RH group) between 2014 and 2019 were included in this study. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method and compared by the Log rank test. The Cox proportional hazards regression model was employed to control for confounders. Results: There were 258 patients in the RH group and 182 patients in the SH group. The two groups had similar 5-year DFS rate (89.25% vs 91.14%, P=0.562) and 5-year OS rate (95.71% vs 94.76%, P=0.482). Multivariable analysis showed that simple hysterectomy was not independently associated with poorer DFS (aHR, 1.608; 95% CI, 0.640-4.041; P=0.312) and OS (aHR, 1.122; 95% CI, P=0.858) than radical hysterectomy for women with stage IA2 cervical cancer. Conclusion: For stage IA2 cervical cancer, a simple hysterectomy is safe and effective. Further studies are needed to testify against our findings.

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Risk of Parametrial Spread in Small Stage I Cervical Carcinoma

Cited by 16 publications

References 32 publications

iPMI: Machine Learning-Aided Identification of Parametrial Invasion in Women with Early-Stage Cervical Cancer

iPMI: Machine Learning-Aided Identification of Parametrial Invasion in Women with Early-Stage Cervical Cancer

Efficacy and safety analysis of non-radical surgery for early-stage cervical cancer (IA2 ~ IB1): a systematic review and meta-analysis

Simple Hysterectomy for Patients with Stage IA2 Cervical Cancer: A Retrospective Cohort Study

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