1
|
Yang Q, Zhou Q, He X, Cai J, Sun S, Huang B, Wang Z. Retrospective analysis of the incidence and predictive factors of parametrial involvement in FIGO IB1 cervical cancer. J Gynecol Obstet Hum Reprod 2021; 50:102145. [PMID: 33848645 DOI: 10.1016/j.jogoh.2021.102145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Radical surgery is the standard primary treatment for patients with stage IB1 (FIGO 2009 staging) cervical cancer due to latent parametrial involvement. Recent studies suggested that less radical surgery was applicable for patients with no or low risk of parametrial involvement. In this study, we aimed to determine the incidence and possible predictive factors of parametrial involvement in patients with stage IB1 cervical cancer so as to evaluate whether less radical surgery was suitable for selected patients. METHODS Clinical data of patients who underwent type C radical hysterectomy with pelvic lymphadenectomy and diagnosed as stage IB1 cervical cancer at Union Hospital, Wuhan, China from October 2014 to December 2017 were collected and analysed retrospectively. The incidence of parametrial involvement was calculated and the risk factors for parametrial involvement were evaluated by univariate and multivariate logistic regression. RESULTS Among 282 eligible patients, 33 (11.7%) had parametrial involvement. Postmenopause, lymphovascular space invasion (LVSI), lymph node metastasis (LNM), deep stromal invasion (outer 1/3) and tumor size larger than 2 cm were statistically associated with parametrial involvement. Multivariate analysis showed that LNM (OR = 11.431; 95%CI: 3.455 - 37.821), deep stromal invasion (OR = 6.080; 95%CI: 1.814 - 20.382) and LVSI (OR = 7.147; 95%CI: 1.863-27.411) remained as independent risk factors for parametrial involvement in patients with stage IB1 cervical cancer. CONCLUSIONS The incidence of parametrial involvement in stage IB1 cervical cancer is non-negligible. Only LNM, LVSI and deep stromal invasion were independent predictors, which were not easy to evaluate accurately before surgery. Less radical surgery requires modified pre-treatment evaluation methods and prospective data support.
Collapse
Affiliation(s)
- Qiang Yang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Qinghui Zhou
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China; Department of Obstetrics and Gynecology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiaoqi He
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Jing Cai
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Si Sun
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Bangxing Huang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China.
| | - Zehua Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China.
| |
Collapse
|
2
|
Kobayashi E, Kanao H, Takekuma M, Nishio S, Kojima-Chiba A, Tozawa A, Yamaguchi S, Takeshima N, Nakatani E, Mikami M. A retrospective assessment of the safety and efficacy of laparoscopic radical hysterectomy in Japan during the early years following its introduction: a Japanese Gynecologic Oncology Group study (JGOG1081S). Int J Clin Oncol 2021; 26:417-428. [PMID: 33433752 DOI: 10.1007/s10147-020-01799-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of laparoscopic radical hysterectomy (LRH) for cervical cancer, in terms of morbidity and short-term oncologic outcome following LRH's introduction into Japan. METHODS We conducted a retrospective analysis of patients with early-stage cervical cancer (FIGO staging IA2, IB1, and IIA1) who underwent LRH from Dec 2014 to Dec 2016. We assessed the morbidity, overall survival (OS) and recurrence-free survival (RFS), and prognostic factors for RFS. RESULTS A total of 251 patients were included from 22 facilities across Japan. There were 8 cases of stage IA2 cervical cancer, 226 of IB1, and 17 of IIA1. The median operating time was 343 min and the median blood loss was 190 ml. Two patients (0.8%) had a postoperative complication with a Clavien-Dindo classification of grade 3 or higher. After a median follow-up time of 15.6 months, the 2-year RFS was 87.4%, and the 2-year OS was 97.8%. When the 2-year RFS rate was compared with whether the patient pathologically had tumors of less than 2 cm, versus 2 cm or more, the RFS was 95.8% and 80.4%, respectively. Multivariate analysis found that tumor size and the route of lymph node removal were independent prognostic factors for recurrence. CONCLUSION When LRH was first introduced into Japan, we found that the route of lymph node removal was an independent prognostic factor for recurrence in addition to large tumors (≥ 2 cm). Our results suggest that prognosis may be secured by paying attention to the lymph node removal route.
Collapse
Affiliation(s)
- Eiji Kobayashi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan.
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital, Tokyo, Japan
| | | | - Shin Nishio
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
| | - Atsumi Kojima-Chiba
- Department of Obstetrics and Gynecology, Faculty of Medicine, Iwate Medical University, Morioka, Japan
| | - Akiko Tozawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Satoshi Yamaguchi
- Department of Gynecologic Oncology, Hyogo Cancer Center, Hyogo, Japan
| | - Nobuhiro Takeshima
- Department of Gynecologic Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Eiji Nakatani
- Division of Statistical Analysis of Research Support Center, Shizuoka General Hospital, Shizuoka, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan
| |
Collapse
|
3
|
Guo J, Yang L, Cai J, Xu L, Min J, Shen Y, Xiong Z, Dong W, Bunyamanop V, Wang Z. Laparoscopic procedure compared with open radical hysterectomy with pelvic lymphadenectomy in early cervical cancer: a retrospective study. Onco Targets Ther 2018; 11:5903-5908. [PMID: 30271174 PMCID: PMC6151097 DOI: 10.2147/ott.s156064] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To compare clinical outcomes in laparoscopic and open radical hysterectomy with pelvic lymphadenectomy (LRH) in early cervical cancer without the selection bias. Methods One special retrospective study was conducted with more than 400 patients involved in laparoscopic procedure. Results Our results suggest that estimated blood loss and transfusion requirements were significantly lower in the LRH group. Postoperative hospital stay was also significantly shorter in the LRH group. Significant difference was found in the number of pelvic lymph nodes retrieved between the LRH and open radical hysterectomy with pelvic lymphadenectomy (ORH) groups. There were no differences in operating time, perioperative complications, progression-free survival, and overall survival between the LRH and ORH groups. Conclusion LRH can be considered a safe and effective alternative to conventional open surgery (ORH) for early-stage cervical cancer.
Collapse
Affiliation(s)
- Jianfeng Guo
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China,
| | - Lu Yang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China,
| | - Jing Cai
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China,
| | - Linjuan Xu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China,
| | - Jie Min
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China,
| | - Yi Shen
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China,
| | - Zhoufang Xiong
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China,
| | - Weihong Dong
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China,
| | - Vichitra Bunyamanop
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China,
| | - Zehua Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China,
| |
Collapse
|
4
|
Cai J, Yang L, Dong W, Wang H, Xiong Z, Wang Z. Retrospective comparison of laparoscopic versus open radical hysterectomy after neoadjuvant chemotherapy for locally advanced cervical cancer. Int J Gynaecol Obstet 2015; 132:29-33. [DOI: 10.1016/j.ijgo.2015.06.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 05/27/2015] [Accepted: 09/10/2015] [Indexed: 01/05/2023]
|
5
|
Yang L, Cai J, Dong W, Shen Y, Xiong Z, Wang H, Min J, Li G, Wang Z. Laparoscopic radical hysterectomy and pelvic lymphadenectomy can be routinely used for treatment of early-stage cervical cancer: a single-institute experience with 404 patients. J Minim Invasive Gynecol 2014; 22:199-204. [PMID: 25281840 DOI: 10.1016/j.jmig.2014.09.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 09/26/2014] [Accepted: 09/26/2014] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE The aim of our study was to determine if laparoscopic radical hysterectomy (LRH) can be routinely used for the treatment of early-stage cervical cancer. DESIGN From May 2008, LRH was planned for all primarily operable cervical cancer patients after receiving informed consent in our department. The surgical and oncologic outcomes were retrospectively evaluated (Canadian Task Force classification III). SETTING University teaching hospital. PATIENTS AND INTERVENTIONS By August 2013, 404 patients with invasive cervical cancer were deemed operable, and all of them were subjected to upfront LRH, except 1 patient who insisted on open surgery. MEASUREMENTS AND MAIN RESULTS The planned LRH was abandoned in 3 patients because of inoperability. The median operative time was 240 minutes (range, 100-410 minutes). The median blood loss was 300 mL (range, 50-800 mL). The median number of harvested pelvic lymph nodes was 23.5 (range, 11-54). Two patients had positive surgical margins. Intraoperative complications occurred in 7 of the patients, and a conversion to open surgery was mandatory for 2 patients (conversion rate = 0.5%). Postoperative urinary tract fistula developed in 3 patients. Sixty-nine patients underwent adjuvant therapy. The median duration of follow-up was 31 months (range, 7-69 months). Thirty patients developed recurrent disease with a median disease-free interval of 12 months (range, 6-23 months), and 24 died of disease. The estimated 3-year overall survival rate was 94.9% in the women with a tumor ≤ IB1 and 81.3% in those with a tumor >IB1, and the 3-year progression-free survival rates were 94.1% and 79.6%, respectively. CONCLUSION LRH is adequate, safe, and feasible for women with cervical cancer, and it can be routinely used for the treatment of early-stage tumors as a primary modality.
Collapse
Affiliation(s)
- Lu Yang
- Department of Obstetrics and Gynecology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Jing Cai
- Department of Obstetrics and Gynecology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Weihong Dong
- Department of Obstetrics and Gynecology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yi Shen
- Department of Obstetrics and Gynecology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Zhoufang Xiong
- Department of Obstetrics and Gynecology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Hongbo Wang
- Department of Obstetrics and Gynecology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Jie Min
- Department of Obstetrics and Gynecology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Guiling Li
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Zehua Wang
- Department of Obstetrics and Gynecology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
| |
Collapse
|
6
|
Shen Y, Yang L, Wang Z. Treatment of early bulky cervical cancer with neoadjuvant paclitaxel, carboplatin and cisplatin prior to laparoscopical radical hysterectomy and pelvic lymphadenectomy. Oncol Lett 2011; 3:641-645. [PMID: 22740967 DOI: 10.3892/ol.2011.529] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 09/29/2011] [Indexed: 11/06/2022] Open
Abstract
The objective of this study was to evaluate the efficacy and safety of neoadjuvant chemotherapy (NAC) with paclitaxel combined with carboplatin and cisplatin prior to laparoscopic radical hysterectomy and pelvic lymphadenectomy. A total of 19 patients who had bulky cervical cancer of International Federation of Gynecology and Obstetrics (FIGO) Stage Ib2 to IIb2 (lesion diameter >4 cm) received NAC with paclitaxel combined with carboplatin and cisplatin prior to laparoscopic radical hysterectomy and pelvic lymphadenectomy. The tumor diameter, the response rate, the resection rate and the lymph node metastasis rate after chemotherapy, as well as the toxicity were evaluated. All patients successfully received NAC, with the exception of 1 patient with FIGO Stage Ib2 and 7 cm tumor diameter, who rejected complete therapy. The tumor diameter was reduced from 4.93±0.81cm before NAC to 2.57±1.90 cm after treatment (P<0.01), and the overall response rate [complete remission (CR) + partial remission (PR)] was 78.9% (15/19). Two patients received radiotherapy after NAC, 1 patient was found to have cystic metastasis during the surgery and the operative rate was 83.3% (15/18). Pelvic lymph node metastasis was found in 2 of the 18 patients (11.1%) without parametrial and vaginal margin involvement. Hematological toxicity was the most common side effect and the 3-4 toxicity level was only 11.1% (2/18). In conclusion, NAC with paclitaxel, combined with carboplatin and cisplatin, followed by laparoscopic radical hysterectomy and pelvic lymphadenectomy was found to be effective and safe. Thus, NAC is the ideal treatment for patients with early bulky cervical cancer.
Collapse
Affiliation(s)
- Yi Shen
- Department of Gynaecology and Obstetrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | | | | |
Collapse
|