Nomogram Predicting the Likelihood of Parametrial Involvement in Early-Stage Cervical Cancer: Avoiding Unjustified Radical Hysterectomies.
cervical cancer
nomogram
parametrial involvement
parametrium
radical hysterectomy
radical trachelectomy
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
05 Jul 2020
05 Jul 2020
Historique:
received:
14
06
2020
revised:
28
06
2020
accepted:
01
07
2020
entrez:
9
7
2020
pubmed:
9
7
2020
medline:
9
7
2020
Statut:
epublish
Résumé
We aimed to establish a tool predicting parametrial involvement (PI) in patients with early-stage cervical cancer and select a sub-group of patients who would most benefit from a less radical surgery. We retrospectively reviewed patients from two prospective multicentric databases-SENTICOL I and II-from 2005 to 2012. Patients with early-stage cervical cancer (FIGO 2018 IA with lympho-vascular involvement to IIA1), undergoing radical surgery (hysterectomy or trachelectomy) with bilateral sentinel lymph node (SLN) mapping with no metastatic node or PI on pre-operative imaging, were included. In total, 5.2% patients (11/211) presented a histologic PI. After univariate analysis, SLN status, lympho-vascular space invasion, deep stromal invasion and tumor size were significantly associated with PI and were included in our nomogram. Our predictive model had an AUC of 0.92 (IC95% = 0.86-0.98) and presented a good calibration. A low risk group, defined according to the optimal sensitivity and specificity, presented a predicted probability of PI of 2%. Patients could benefit from a two-step approach. Final surgery (i.e. radical surgery and/or lymphadenectomy) would depend on the SLN status and the probability PI calculated after an initial conization with bilateral SLN mapping.
Sections du résumé
BACKGROUND
BACKGROUND
We aimed to establish a tool predicting parametrial involvement (PI) in patients with early-stage cervical cancer and select a sub-group of patients who would most benefit from a less radical surgery.
METHODS
METHODS
We retrospectively reviewed patients from two prospective multicentric databases-SENTICOL I and II-from 2005 to 2012. Patients with early-stage cervical cancer (FIGO 2018 IA with lympho-vascular involvement to IIA1), undergoing radical surgery (hysterectomy or trachelectomy) with bilateral sentinel lymph node (SLN) mapping with no metastatic node or PI on pre-operative imaging, were included.
RESULTS
RESULTS
In total, 5.2% patients (11/211) presented a histologic PI. After univariate analysis, SLN status, lympho-vascular space invasion, deep stromal invasion and tumor size were significantly associated with PI and were included in our nomogram. Our predictive model had an AUC of 0.92 (IC95% = 0.86-0.98) and presented a good calibration. A low risk group, defined according to the optimal sensitivity and specificity, presented a predicted probability of PI of 2%.
CONCLUSION
CONCLUSIONS
Patients could benefit from a two-step approach. Final surgery (i.e. radical surgery and/or lymphadenectomy) would depend on the SLN status and the probability PI calculated after an initial conization with bilateral SLN mapping.
Identifiants
pubmed: 32635657
pii: jcm9072121
doi: 10.3390/jcm9072121
pmc: PMC7408823
pii:
doi:
Types de publication
Journal Article
Langues
eng
Références
Am J Obstet Gynecol. 2008 Sep;199(3):242.e1-6
pubmed: 18486092
Int J Gynecol Cancer. 2020 Mar;30(3):358-363
pubmed: 31911532
Epidemiology. 2005 Jan;16(1):73-81
pubmed: 15613948
Gynecol Oncol. 2007 May;105(2):475-80
pubmed: 17292460
Gynecol Oncol. 2013 Sep;130(3):525-9
pubmed: 23500089
J Am Coll Surg. 2005 Dec;201(6):913-7
pubmed: 16310695
Obstet Gynecol. 2009 Jul;114(1):93-9
pubmed: 19546764
Gynecol Oncol. 2013 Dec;131(3):708-13
pubmed: 24125751
Stat Med. 1996 Feb 28;15(4):361-87
pubmed: 8668867
Gynecol Oncol. 2009 May;113(2):181-4
pubmed: 19264352
Gynecol Oncol. 2003 Oct;91(1):59-66
pubmed: 14529663
Eur J Obstet Gynecol Reprod Biol. 2016 Mar;198:84-88
pubmed: 26802255
Gynecol Oncol. 2001 Jan;80(1):3-12
pubmed: 11136561
Gynecol Oncol. 2012 Mar;124(3):496-501
pubmed: 22120175
Int J Gynecol Cancer. 2007 May-Jun;17(3):629-36
pubmed: 17309561
Am J Obstet Gynecol. 2008 Aug;199(2):151.e1-4
pubmed: 18674657
Gynecol Oncol. 2010 Dec;119(3):426-30
pubmed: 20822804
J Gynecol Oncol. 2015 Apr;26(2):90-9
pubmed: 25872890
Gynecol Oncol. 2011 Nov;123(2):230-5
pubmed: 21893335
J Gynecol Oncol. 2015 Oct;26(4):255-61
pubmed: 26197769
Cancer. 2000 May 15;88(10):2267-74
pubmed: 10820348
Int J Gynecol Cancer. 2019 Mar;29(3):447-452
pubmed: 30833435
J Transl Med. 2018 Jun 14;16(1):163
pubmed: 29898732
Jpn J Clin Oncol. 2007 May;37(5):370-5
pubmed: 17556538
Radiology. 1982 Apr;143(1):29-36
pubmed: 7063747
Gynecol Oncol. 2016 Jul;142(1):109-114
pubmed: 27179979
Gynecol Oncol. 1995 Apr;57(1):3-6
pubmed: 7705699
Lancet Oncol. 2010 Mar;11(3):292-301
pubmed: 20202614
Eur J Obstet Gynecol Reprod Biol. 2017 Sep;216:212-223
pubmed: 28810192
Cancer. 2007 Sep 15;110(6):1281-6
pubmed: 17654664
J Gynecol Oncol. 2019 May;30(3):e34
pubmed: 30887756
Oncol Res Treat. 2016;39(7-8):432-8
pubmed: 27487047
Gynecol Oncol. 2004 May;93(2):307-14
pubmed: 15099938
Gynecol Oncol. 2008 May;109(2):280-4
pubmed: 18377965
Gynecol Oncol. 2002 Jan;84(1):145-9
pubmed: 11748991
Ann Surg Oncol. 2017 Oct;24(11):3406-3412
pubmed: 28785898
Int J Gynecol Cancer. 2020 Apr;30(4):456-465
pubmed: 32193220
Gynecol Oncol. 2019 Jan;152(1):202-207
pubmed: 30318103
PLoS One. 2018 Oct 18;13(10):e0204950
pubmed: 30335786
Lancet Oncol. 2008 Mar;9(3):297-303
pubmed: 18308255
Med Ultrason. 2020 Mar 1;22(1):85-91
pubmed: 32096793
J Am Coll Surg. 2002 Oct;195(4):513-9
pubmed: 12375757
Gynecol Oncol. 2007 Jul;106(1):251-6
pubmed: 17490734
N Engl J Med. 2018 Nov 15;379(20):1895-1904
pubmed: 30380365