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Blackman A, Creasman W. A Case for the Conservative Management of Stage IA Cervical Cancer. Cancers (Basel) 2023; 15:5051. [PMID: 37894417 PMCID: PMC10605599 DOI: 10.3390/cancers15205051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/19/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
Cervical cancer remains a significant public health concern within the United States and across the world. Cervical cancer is most frequently diagnosed in women between the ages of 35 and 44 and therefore affects a younger patient population than many other cancers. The management of early-stage disease has frequently utilized radical hysterectomy with the associated increased surgical morbidity, without clear evidence of any benefits. In stage IA disease, there are retrospective pathologic data supporting the safety of conservative surgery and lymphadenectomy over radical hysterectomy. There are also emerging prospective studies supporting conservative management. This editorial presents the evidence for conservative management of stage IA cervical cancer by reviewing the existing retrospective studies as well as the ongoing prospective studies.
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Affiliation(s)
- Alexandra Blackman
- Department of Obstetrics & Gynecology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - William Creasman
- Department of Obstetrics & Gynecology, Medical University of South Carolina, Charleston, SC 29425, USA
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Does the New FIGO 2018 Staging System Allow Better Prognostic Differentiation in Early Stage Cervical Cancer? A Dutch Nationwide Cohort Study. Cancers (Basel) 2022; 14:cancers14133140. [PMID: 35804912 PMCID: PMC9265081 DOI: 10.3390/cancers14133140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary The introduction of a revised staging system (FIGO 2018 staging system) for cervical cancer has led to a significant change in stage allocation for patients with early stage disease. It remains unclear how this change should be translated into treatment options, including less extensive surgery. With this Dutch national study we evaluated whether the revised staging system resulted in a more accurate prediction of overall and recurrence free survival compared to the previous FIGO 2009 staging system. In addition, we assessed other factors which may help the paradigm of treatment. We concluded that the revised FIGO 2018 staging system gives a more precise indication of survival outcomes of women with early stage cervical cancer. In addition, we believe that aside from stage, tumor characteristics, such as LVSI, and depth of invasion should be considered when offering patients less radical or less extensive treatment. Abstract The FIGO 2018 staging system was introduced to allow better prognostic differentiation in cervical cancer, causing considerable stage migration and affecting treatment options. We evaluated the accuracy of the FIGO 2018 staging in predicting recurrence free (RFS) and overall survival (OS) compared to FIGO 2009 staging in clinically early stage cervical cancer. We conducted a nationwide retrospective cohort study, including 2264 patients with preoperative FIGO (2009) IA1, IA2 and IB1 cervical cancer between 2007–2017. Kaplan–Meier analyses were used to assess survival outcomes. Logistic regression was used to assess risk factors for lymph node metastasis and parametrial invasion. Stage migration occurred in 48% (22% down-staged, 26% up-staged). Survival data of patients down-staged from IB to IA1/2 disease were comparable with FIGO 2009 IA1/2 and better than patients remaining stage IB1. LVSI, invasion depth and parametrial invasion were risk factors for lymph node metastases. LVSI, grade and age were associated with parametrial invasion. In conclusion, the FIGO 2018 staging system accurately reflects prognosis in early stage cervical cancer and is therefore more suitable than the FIGO 2009 staging. However subdivision in IA1 or IA2 based on presence or absence of LVSI instead of depth of invasion would have improved accuracy. For patients down-staged to IA1/2, less radical surgery seems appropriate, although LVSI and histology should be considered when determining the treatment plan.
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Olthof EP, Mom CH, Snijders MLH, Wenzel HHB, van der Velden J, van der Aa MA. The prognostic value of the number of positive lymph nodes and the lymph node ratio in early-stage cervical cancer. Acta Obstet Gynecol Scand 2022; 101:550-557. [PMID: 35218205 DOI: 10.1111/aogs.14316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/10/2021] [Accepted: 01/04/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION To establish the impact of the number of lymph node metastases (nLNM) and the lymph node ratio (LNR) on survival in patients with early-stage cervical cancer after surgery. MATERIAL AND METHODS In this nationwide historical cohort study, all women diagnosed between 1995 and 2020 with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA2-IIA1 cervical cancer and nodal metastases after radical hysterectomy and pelvic lymphadenectomy from the Netherlands Cancer Registry were selected. Optimal cut-offs for prognostic stratification by nLNM and LNR were calculated to categorize patients into low-risk or high-risk groups. Kaplan-Meier overall survival analysis and flexible parametric relative survival analysis were used to determine the impact of nLNM and LNR on survival. Missing data were imputed. RESULTS The optimal cut-off point was ≥4 for nLNM and ≥0.177 for LNR. Of the 593 women included, 500 and 501 (both 84%) were categorized into the low-risk and 93 and 92 (both 16%) into the high-risk groups for nLNM and LNR, respectively. Both high-risk groups had a worse 5-year overall survival (p < 0.001) compared with the low-risk groups. Being classified into the high-risk groups is an independent risk factor for relative survival, with excess hazard ratios of 2.4 (95% confidence interval 1.6-3.5) for nLNM and 2.5 (95% confidence interval 1.7-3.8) for LNR. CONCLUSIONS Presenting a patient's nodal status postoperatively by the number of positive nodes, or by the nodal ratio, can support further risk stratification regarding survival in the case of node-positive early-stage cervical cancer.
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Affiliation(s)
- Ester P Olthof
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.,Department of Gynecological Oncology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Constantijne H Mom
- Department of Gynecological Oncology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Malou L H Snijders
- Department of Pathology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans H B Wenzel
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Jacobus van der Velden
- Department of Gynecological Oncology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Maaike A van der Aa
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
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Bucchi L, Costa S, Mancini S, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, Zamagni F, Giorgi Rossi P, Campari C, Canuti D, Sassoli de Bianchi P, Ferretti S, Falcini F. Clinical Epidemiology of Microinvasive Cervical Carcinoma in an Italian Population Targeted by a Screening Programme. Cancers (Basel) 2022; 14:cancers14092093. [PMID: 35565224 PMCID: PMC9103092 DOI: 10.3390/cancers14092093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/29/2022] [Accepted: 04/15/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary According to this population-based study, 3750 patients living in the Emilia-Romagna Region (northern Italy) were registered with cervical carcinoma between 1995–2016, including 2942 eligible patients. The likelihood of stage IA cervical carcinoma (n = 876, 29.8%) did not change over time, decreased with increasing patient age, and was lower for patients with adenocarcinoma and grade 3–4 disease. Three hundred and fifty (40.0%) patients had a conservative treatment, 317 (36.2%) had hysterectomy, 197 (22.5%) had hysterectomy with lymph node dissection (LND), and 12 (1.4%) had a conservative treatment with LND. The proportion of hysterectomy decreased from 70.6% in 1995–1999 to 46.9% in 2011–2016. The likelihood of hysterectomy increased above the age of 40. Among screening-aged (25–64 years) patients, the likelihood of hysterectomy did not differ between screen-detected and non-screen-detected ones. Hysterectomy was increasingly combined with LND. High tumour grade was the strongest determinant of LND during hysterectomy. Abstract (1) Background: This population-based study aimed at identifying the factors associated with the likelihood of detection of stage IA cervical carcinoma—versus the detection of stage IB through IV cervical carcinoma—and the patterns of surgical treatment. (2) Methods: Between 1995–2016, 3750 patients living in the Emilia-Romagna Region (northern Italy) were registered with cervical carcinoma, including 2942 eligible patients (median age, 53). Multivariate analysis was performed using binary logistic regression models. (3) Results: The likelihood of stage IA cervical carcinoma (n = 876, 29.8%) did not change over time, decreased with increasing patient age, and was lower for patients with adenocarcinoma and grade 3–4 disease. Three hundred and fifty (40.0%) patients had a conservative treatment, 317 (36.2%) had hysterectomy, 197 (22.5%) had hysterectomy with lymph node dissection (LND), and 12 (1.4%) had a conservative treatment with LND. The proportion of hysterectomy decreased from 70.6% in 1995–1999 to 46.9% in 2011–2016. The likelihood of hysterectomy increased above the age of 40. Among screening-aged (25–64 years) patients, the likelihood of hysterectomy did not differ between screen-detected and non-screen-detected ones. Hysterectomy was increasingly combined with LND. High tumour grade was the strongest determinant of LND during hysterectomy. (4) Conclusions: This study provided a multifaceted overview of stage IA cervical carcinoma over the last decades.
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Affiliation(s)
- Lauro Bucchi
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (L.B.); (F.B.); (O.G.); (A.R.); (R.V.); (F.Z.); (F.F.)
| | - Silvano Costa
- Department of Gynaecology, Madre Fortunata Toniolo Hospital, 40141 Bologna, Italy;
| | - Silvia Mancini
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (L.B.); (F.B.); (O.G.); (A.R.); (R.V.); (F.Z.); (F.F.)
- Correspondence:
| | - Flavia Baldacchini
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (L.B.); (F.B.); (O.G.); (A.R.); (R.V.); (F.Z.); (F.F.)
| | - Orietta Giuliani
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (L.B.); (F.B.); (O.G.); (A.R.); (R.V.); (F.Z.); (F.F.)
| | - Alessandra Ravaioli
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (L.B.); (F.B.); (O.G.); (A.R.); (R.V.); (F.Z.); (F.F.)
| | - Rosa Vattiato
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (L.B.); (F.B.); (O.G.); (A.R.); (R.V.); (F.Z.); (F.F.)
| | - Federica Zamagni
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (L.B.); (F.B.); (O.G.); (A.R.); (R.V.); (F.Z.); (F.F.)
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Cinzia Campari
- Cancer Screening Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Debora Canuti
- Department of Health, Emilia-Romagna Region, 40127 Bologna, Italy; (D.C.); (P.S.d.B.)
| | | | - Stefano Ferretti
- Department of Translational Medicine, University of Ferrara and Local Health Authority, 44121 Ferrara, Italy;
| | - Fabio Falcini
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (L.B.); (F.B.); (O.G.); (A.R.); (R.V.); (F.Z.); (F.F.)
- Local Health Authority, 47121 Forlì, Italy
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Hartman CA, Bragança JF, Gurgel MSC, Zeferino LC, Andrade LALA, Teixeira JC. Conservative treatment of microinvasive squamous cell carcinoma of the cervix stage IA1: Defining conization height to an optimal oncological outcome. PLoS One 2021; 16:e0253998. [PMID: 34283862 PMCID: PMC8291715 DOI: 10.1371/journal.pone.0253998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/18/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This paper searches an ideal cone height for stage definition and safe treatment of cervical microinvasive squamous carcinoma stage IA1 (MIC IA1), avoiding excessive cervix resection, favoring a future pregnancy. METHODS A retrospective study was performed involving 562 women with MIC IA1, from 1985 to 2013, evaluating cone margin involvement, depth of stromal invasion, lymph vascular invasion, conization height, and residual uterine disease (RD). High-grade squamous lesions or worse detection was considered recurrence. Univariate and multivariate regression analyses were performed, including age, conization technique (CKC, cold-knife, or ETZ, excision of transformation zone), and pathological results. Conization height to provide negative margins and the risk of residual disease were analyzed. RESULTS Conization was indicated by biopsy CIN2/3 in 293 cases. Definitive treatments were hysterectomy (69.8%), CKC (20.5%), and ETZ (9.7%). Recurrence rate was 5.5%, more frequent in older women (p = 0.030), and less frequent in the hysterectomy group (p = 0.023). Age ≥40 years, ETZ and conization height are independent risk factors for margin involvement. For ages <40 years, 10 mm cone height was associated with 68.6% Negative Predictive Value (NPV) for positive margins, while for 15 mm and 25 mm, the NPV was 75.8% and 96.2%, respectively. With negative margins, the NPV for RD varied from 85.7-92.3% for up to 24 mm cone height and 100% from 25 mm. CONCLUSION Conization 10 mm height for women <40 years provided adequate staging for almost 70%, with 10% of RD and few recurrences. A personalized cone height and staging associated with conservative treatment are recommended.
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Affiliation(s)
- Caio A. Hartman
- Department of Obstetrics and Gynecology, Gynecology Oncology Area, State University of Campinas (Unicamp), Sao Paulo, Brazil
| | - Joana F. Bragança
- Department of Obstetrics and Gynecology, Gynecology Oncology Area, State University of Campinas (Unicamp), Sao Paulo, Brazil
| | - Maria Salete C. Gurgel
- Department of Obstetrics and Gynecology, Gynecology Oncology Area, State University of Campinas (Unicamp), Sao Paulo, Brazil
| | - Luiz C. Zeferino
- Department of Obstetrics and Gynecology, Gynecology Oncology Area, State University of Campinas (Unicamp), Sao Paulo, Brazil
| | | | - Julio C. Teixeira
- Department of Obstetrics and Gynecology, Gynecology Oncology Area, State University of Campinas (Unicamp), Sao Paulo, Brazil
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Olthof EP, van der Aa MA, Adam JA, Stalpers LJA, Wenzel HHB, van der Velden J, Mom CH. The role of lymph nodes in cervical cancer: incidence and identification of lymph node metastases-a literature review. Int J Clin Oncol 2021; 26:1600-1610. [PMID: 34241726 DOI: 10.1007/s10147-021-01980-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/24/2021] [Indexed: 01/15/2023]
Abstract
Correct identification of patients with lymph node metastasis from cervical cancer prior to treatment is of great importance, because it allows more tailored therapy. Patients may be spared unnecessary surgery or extended field radiotherapy if the nodal status can be predicted correctly. This review captures the existing knowledge on the identification of lymph node metastases in cervical cancer. The risk of nodal metastases increases per 2009 FIGO stage, with incidences in the pelvic region ranging from 2% (stage IA2) to 14-36% (IB), 38-51% (IIA) and 47% (IIB); and in the para-aortic region ranging from 2 to 5% (stage IB), 10-20% (IIA), 9% (IIB), 13-30% (III) and 50% (IV). In addition, age, tumor size, lymph vascular space invasion, parametrial invasion, depth of stromal invasion, histological type, and histological grade are reported to be independent prognostic factors for the risk of nodal metastases. Furthermore, biomarkers can contribute to predict a patient's nodal status, of which the squamous cell carcinoma antigen (SCC-Ag) is currently the most widely used in squamous cell cervical cancer. Still, pre-treatment lymph node assessment is primarily performed by imaging, of which diffusion-weighted magnetic resonance imaging has the highest sensitivity and 2-deoxy-2-[18F]fluoro-D-glucose positron emission computed tomography the highest specificity. Imaging results can be combined with clinical parameters in nomograms to increase the accuracy of predicting positives nodes. Despite all the progress regarding pre-treatment prediction of lymph node metastases in cervical cancer in recent years, prediction rates are not robust enough to safely abandon surgical staging of the pelvic or para-aortic region yet.
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Affiliation(s)
- Ester P Olthof
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Postbus 19079, 3501 DB, Utrecht, The Netherlands.
| | - Maaike A van der Aa
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Judit A Adam
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Lukas J A Stalpers
- Department of Radiation Oncology, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hans H B Wenzel
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Jacobus van der Velden
- Department of Gynaecological Oncology, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Constantijne H Mom
- Department of Gynaecological Oncology, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Wenzel HHB, Van Kol KGG, Nijman HW, Lemmens VEPP, Van der Aa MA, Ebisch RMF, Bekkers RLM. Cervical cancer with ≤5 mm depth of invasion and >7 mm horizontal spread - Is lymph node assessment only required in patients with LVSI? Gynecol Oncol 2020; 158:282-286. [PMID: 32381363 DOI: 10.1016/j.ygyno.2020.04.705] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/24/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Cervical cancer with ≤5 mm depth of invasion and >7 mm horizontal spread is classified FIGO IA instead of FIGO IB in the revised staging system, as horizontal spread is no longer considered. We aimed to determine the incidence of lymph node metastasis (LNM) and, consequently, the necessity of pelvic lymph node assessment. METHODS Patients diagnosed between January 2015 and May 2019 with cervical cancer FIGO (2009) stage IB with ≤5 mm depth of invasion and >7 mm horizontal spread, were identified from the Netherlands Cancer Registry. Associations between disease-characteristics and lymph node metastasis (LNM), and overall survival, were assessed. RESULTS Of 170 patients, six (3.5%) had LNM: 4/53 (7.6%) with adenocarcinoma and 2/117 (1.7%) with squamous cell carcinoma (p = .077). Four-year overall survival was 98.2%. LNM was observed more often in tumours with LVSI (4/43 patients, 9.3%) than without LVSI (2/117 patients, 1.7%) (p = .045). In adenocarcinoma with 3-5 mm depth of invasion LNM rate was 10% (4/40). None of the following tumours were observed with LNM: squamous cell carcinoma without LVSI (0/74); adenocarcinoma with <3 mm depth of invasion (0/13); <3 mm depth of invasion without LVSI (0/36). CONCLUSIONS Lymph node assessment is essential in any tumour with LVSI or in adenocarcinoma with 3-5 mm depth of invasion. It can be omitted in squamous cell carcinoma without LVSI, in adenocarcinoma with <3 mm depth of invasion and in any tumours without LVSI and with <3 mm depth of invasion.
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Affiliation(s)
- Hans H B Wenzel
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
| | - Kim G G Van Kol
- Department of Obstetrics and Gynaecology, Catherina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Valery E P P Lemmens
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Maaike A Van der Aa
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Renée M F Ebisch
- Department of Obstetrics and Gynaecology, Catherina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, Catherina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands; Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Sun H, Cao D, Shen K, Yang J, Xiang Y, Feng F, Wu L, Zhang Z, Ling B, Song L. Piver Type II vs. Type III Hysterectomy in the Treatment of Early-Stage Cervical Cancer: Midterm Follow-up Results of a Randomized Controlled Trial. Front Oncol 2018; 8:568. [PMID: 30555800 PMCID: PMC6280766 DOI: 10.3389/fonc.2018.00568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/13/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: With the expansion of value-based medicine, we explore whether using type III hysterectomy to treat low-risk, early-stage cervical cancer constitutes overtreatment. In present study, we evaluate the midterm safety and postoperative quality of life of patients who underwent type II hysterectomy vs. type III hysterectomy with systematic lymphadenectomy for low-risk early-stage cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) IA2-IB1; maximum tumor diameter < 2 cm). Patients and methods: The main study was a multicenter, phase III, randomized controlled trial (NCT02368574, https://www.clinicaltrials.gov/ct2/show/NCT02368574). Patients meeting the criteria were randomly divided into type II and type III hysterectomy groups between 2015 and 2018. Midterm outcomes were analyzed at 36 months after the first eligible patient was enrolled. The primary end point was disease-free survival, and the secondary end point was postoperative quality of life. Results: A total of 97 patients were preliminarily enrolled, 93 of whom were included in the final analysis. The general information of the two groups did not differ. The 2-year DFS rate in the type II group was 100% compared with 97.9% in the type III group (P > 0.05). Compared to the type III group, the patients who underwent type II hysterectomy showed a shorter surgical time (163 ± 18.8 min vs. 226 ± 16.4 min, P = 0.014), less intraoperative blood loss (174 ± 27.7 ml vs. 268 ± 37.4 ml, P = 0.047), less postoperative urinary retention (5/46 vs. 11/47 cases, P = 0.109), and milder bladder injuries. The postoperative symptom experience scores of the type II group were significantly lower than those of the type III group. Moreover, the postoperative sexual/vaginal functioning and lubrication scores of the type II group were significantly lower than those of the type III group in subgroup analyses of patients who did not undergo postoperative chemoradiotherapy. Sexual apprehension scores were increased postoperatively in both groups. Conclusion: Based on the midterm analysis, the two groups show considerable security within 2 years after surgery, but long-term security requires further analysis. Type II hysterectomy can effectively reduce the surgical time and intraoperative blood loss, decrease postoperative complications, and improve the quality of life of early-stage cervical cancer patients.
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Affiliation(s)
- Hengzi Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengzhi Feng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingying Wu
- Department of Gynecological Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Zhenyu Zhang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Beijing, China
| | - Bin Ling
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, China
| | - Lei Song
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China
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Dai YF, Xu M, Zhong LY, Xie XY, Liu ZD, Yan MX, Yi H, Lin DM. Prognostic significance of solitary lymph node metastasis in patients with stages IA2 to IIA cervical carcinoma. J Int Med Res 2018; 46:4082-4091. [PMID: 29963935 PMCID: PMC6166324 DOI: 10.1177/0300060518785827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the prognostic significance of and risk factors for solitary lymph node metastasis (SLNM) of patients with cervical carcinoma. Methods Clinical data from patients with International Federation of Gynecology and Obstetrics (FIGO) stages IA2 to IIA cervical carcinoma who underwent radical hysterectomy and pelvic lymphadenectomy between January 2003 and December 2010 were analysed retrospectively. Histopathological analysis was used to identify SLNM. Long-term survival and risk factors associated with SLNM were analysed. Results The study enrolled 302 patients with cervical cancer: 48 with SLNM (SLNM group) and 254 patients with no lymph node metastases (nLNM group). FIGO stage, tumour grade, depth of tumour invasion, uterine body involvement, parametrial involvement and lymphovascular invasion differed significantly between the two groups. Logistic regression analysis revealed that FIGO stage, depth of tumour invasion and lymphovascular invasion were independent factors associated with SLNM. The 5-year survival rates of the SLNM and nLNM groups were 54.2% and 87.8%, respectively. Multivariate analysis identified SLNM as an independent factor affecting survival. Conclusions The occurrence of just one solitary lymph node metastasis significantly worsened the prognosis in patients with cervical carcinoma compared with patients without lymph node metastases.
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Affiliation(s)
- Yi-Fang Dai
- Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Mu Xu
- Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Li-Ying Zhong
- Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Xiao-Yan Xie
- Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Zhao-Dong Liu
- Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Ming-Xing Yan
- Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Huan Yi
- Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Dan-Mei Lin
- Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
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