Retrospective analysis of the incidence and predictive factors of parametrial involvement in FIGO IB1 cervical cancer
Retrospective analysis of the incidence and predictive factors of parametrial involvement in FIGO IB1 cervical cancer
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DOI：
10.1016/j.jogoh.2021.102145
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发表时间：
2021-04-21
影响因子：
1.9
通讯作者：
Wang, Zehua
中科院分区：
文献类型：
--
作者：
Yang, Qiang;Zhou, Qinghui;Wang, Zehua
背景和目的：根治性手术是IB1期(FIGO 2009分期)宫颈癌患者的标准主要治疗方法，原因是潜在的宫旁受累。最近的研究表明，对于没有宫旁受累风险或风险较低的患者，较小的根治性手术是适用的。本研究旨在了解宫旁受累的IB1期宫颈癌患者的发生率及可能的预测因素，以评估是否适合选择较小的根治性手术。方法：对2014年10月至2017年12月在武汉市协和医院接受C型根治性子宫切除加盆腔淋巴清扫并诊断为IB1期宫颈癌的患者的临床资料进行回顾性分析。结果：在符合条件的282例患者中，33例(11.7%)发生宫旁受累。绝经后、淋巴血管侵犯(LVSI)、淋巴结转移(LNM)、深层间质侵犯(外1/3)、肿瘤直径>2 cm与宫旁受累有统计学意义。多因素分析显示，宫旁转移(OR=11.431；95%CI：3.455~37.821)、深层间质侵犯(OR=6.080；95%CI：1.814~20.382)和左心室指数(OR=7.147；95%CI：1.863~27.411)仍是宫旁受累的独立危险因素。只有LNM、LVSI和深部间质侵犯是独立的预测因素，术前不易准确评估。较小的根治性手术需要改进的治疗前评估方法和前瞻性数据支持。(C)2021年提交人。爱思唯尔·马森公司出版。
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. (C) 2021 The Authors. Published by Elsevier Masson SAS.