The significance of microscopic involvement of the parametrium and/or pelvic lymph nodes in cervical cancer stages IB and IIA

Bleker, O. P.; Ketting, B.W.; Wayjen-Eecen, B. van; Kloosterman, G.J.

doi:10.1016/0090-8258(83)90009-4

Cited by 44 publications

(14 citation statements)

References 8 publications

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“…Reported incidences of parametrial extension in early stages varied between 7% and 16.8% [13,60,64]. There is a good correlation between parametrial extension and the incidence of lymph node metastases and recurrence [13,16,60,64,82,98].…”

Section: Parametrial Extensionmentioning

confidence: 94%

“…Postoperative pelvic radiation for patients with lymph node metastases and parametrial extension of lymph-blood vessel invasion has been investigated in several studies. Some authors reported a slightly improved survival rate [41,53,68,86], but the majority [13,16,30,47,60,91,120,139] did not find a better survival rate with this additional treatment. Unfortunately all these studies were retrospective and used non-randomized analysis.…”

Section: The Impact Of Treatmentmentioning

confidence: 99%

“…Pejovic et al [103], Fuller et al [47] and Kortmeier [73] described a better prognosis for patients with squamous cell carcinoma than for patients with adenocarcinoma. Others [7,13,16,30,98], however, found no cell-type dependent differences in prognosis, Swan et al [124] found a better survival rate with large non-keratinizing carcinomas compared with parvocellular carcinomas after radiotherapy, but not after surgical treatment, suggesting that parvoqllular carcinomas are less radiosensitive. In summary, it is still doubtful whether cell type is of prognostic significance.…”

Section: Histology: Cell Differentiation and Cell Typementioning

confidence: 99%

“…A combination of certain factors apparently has a worse prognosis than those factors separately. Bleker et al [13] and Inoue [64], for example, found a significantly lower survival rate in patients with parametrial extension and lymph node metastases together when compared to patients in whom only one of these factors was present. The first author noted a 5-year survival rate of 50% if parametrial extension and lymph nodes were positive.…”

Section: The Main Prognostic Factorsmentioning

confidence: 99%

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A review of prognostic factors in early-stage carcinoma of the cervix (FIGO I B and II A) and implications for treatment strategy

Bommel¹,

Lindert²,

Kock³

et al. 1987

European Journal of Obstetrics & Gynecology and Reproductiv

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Several prognostic factors in stages I B and II A cervical carcinoma have been widely studied to define groups of patients with a poor prognosis. Most of these factors are interrelated. The characteristics which should be regarded as main factors have not yet been defined, because the studies reported were based on mainly retrospective and non-randomized analysis. Reviewing the literature, lymph node metastasis, differentiation grade, tumor size, parametrial extension, lymphblood vessel invasion and cervical invasion seem to be prognostically important factors, which suggests that the subdivision of patients according to the FIG0 classification alone is inaccurate. It seems useful to define subgroups of patients according to tumor characteristics, determined after surgical treatment and accurate histologic examination of the surgical specimen. Patients with one or more of these tumor features need additional treatment to improve survival. The current treatment modalities, such as postoperative radiotherapy, have not been thoroughly evaluated, but doubt exists as to their efficacy. Data in the literature suggest that particularly patients with para-aortic or multiple pelvic lymph node metastasis (> 3) have already developed distant metastases at the time of primary treatment and therefore need adjuvant systemic therapy. Patients with tumors larger than 4 cm in diameter, differentiation grade III, lymph-blood vessel invasion or cervical invasion (of more than 70%) seem to have high recurrence rates at both pelvic and distant sites, indicating that there is also a need for better pelvic control.

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Section: Parametrial Extensionmentioning

confidence: 94%

Section: The Impact Of Treatmentmentioning

confidence: 99%

Section: Histology: Cell Differentiation and Cell Typementioning

confidence: 99%

Section: The Main Prognostic Factorsmentioning

confidence: 99%

See 2 more Smart Citations

A review of prognostic factors in early-stage carcinoma of the cervix (FIGO I B and II A) and implications for treatment strategy

Bommel¹,

Lindert²,

Kock³

et al. 1987

European Journal of Obstetrics & Gynecology and Reproductiv

View full text Add to dashboard Cite

show abstract

“…However, the clinical staging is not always correct (Nagell et al, 1971). Pelvic lymph node metastases are found in 18-24% of these patients and 15-20% have tumour spread into the parametria (Ketting, 1981;Bleker et al, 1983). In these cases additional radiotherapy is given, which means that the patients are then subjected to the risk of complications from both therapies.…”

mentioning

confidence: 99%

Pretreatment tumour-antigen Ta-4 in serum of patients with squamous cell carcinoma of the uterine cervix

Kenter

Bonfrèr²,

Heintz³

1987

Br J Cancer

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Utility of parametrectomy for early stage cervical cancer treated with radical hysterectomy

Wright

Grigsby

Brooks

et al. 2007

Cancer

181

128

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BACKGROUND. Removal of the parametrial soft tissue is recommended for patients with cervical cancer undergoing radical hysterectomy. Parametrectomy results in significant morbidity. The objective of the study was to determine factors predictive of parametrial tumor spread and to define a subset of patients at low risk for parametrial disease. METHODS. Patients with invasive cervical cancer who underwent radical hysterectomy from 1989–2005 were examined. Analysis was performed to determine factors associated with parametrial tumor spread. Survival estimates were determined using the Kaplan‐Meier method. RESULTS. A total of 594 patients were identified. Parametrial metastases were documented in 64 (10.8%). Factors associated with parametrial disease were: histology, advanced grade, deep cervical invasion, lymphovascular space invasion (LVSI), large tumor size, advanced stage, uterine or vaginal involvement, and pelvic or para‐aortic lymph node metastases (P < .0001 for each). Parametrial metastases were associated with increased risk of recurrence and decreased disease‐free and overall survivals (P < .0001). A subgroup analysis was performed to identify patients at low risk for parametrial spread. In pelvic node‐negative women parametrial disease was noted in 6.0% (30/498) compared with 47.9% (34 of 71) of those with positive pelvic nodes (P < .0001). If further stratified to women with negative nodes, no LVSI, and tumors < 2 cm, the incidence of parametrial disease was only 0.4%. CONCLUSIONS. Parametrial spread is a strong predictor of recurrence and decreased survival. Parametrial invasion is rare in patients with small tumors, no LVSI, and negative pelvic nodes (no poor prognostic factors). Further study is warranted to determine the feasibility of omitting parametrectomy in these low‐risk patients. Cancer 2007. © 2007 American Cancer Society.

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The significance of microscopic involvement of the parametrium and/or pelvic lymph nodes in cervical cancer stages IB and IIA

Cited by 44 publications

References 8 publications

A review of prognostic factors in early-stage carcinoma of the cervix (FIGO I B and II A) and implications for treatment strategy

A review of prognostic factors in early-stage carcinoma of the cervix (FIGO I B and II A) and implications for treatment strategy

Pretreatment tumour-antigen Ta-4 in serum of patients with squamous cell carcinoma of the uterine cervix

Utility of parametrectomy for early stage cervical cancer treated with radical hysterectomy

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