Abstract
BackgroundThe aim of the present article was to evaluate whether angiogenic parameters as assessed by transvaginal color Doppler ultrasound (TVCD) may predict those prognostic factors related to recurrence.MethodsA total of 27 patients (mean age: 51.3 years, range: 29 to 85) with histologically proven early stage invasive cervical cancer were evaluated by TVCD prior to surgery. Subjective assessment of the amount of vessels within the tumor (scanty-moderate or abundant) and pulsatility index (PI) were recorded. All patients underwent radical hysterectomy and pelvic lymph node dissection. Postoperative treatment (RT or chemoradiotherapy) was given according to risk factors (positive lymph nodes, parametrial and vaginal margin involvement, depth stromal invasion, lymph-vascular space involvement)ResultsTumors with "abundant" vascularization were significantly associated with pelvic lymph node metastases, depth stromal invasion > 10 mm, lymph-vascular space involvement, tumor diameter > 17.5 mm, and parametrial involvement. Postoperative treatment was significantly more frequent in patients with "abundant" vascularization (OR: 20.8, 95% CIs: 2 to 211). The presence of scanty-moderate vascularization with a PI < 0.82 or abundant vascularization with either PI > 0.82 or PI < 0.82 was associated with high-risk group in 94.4% of the cases (OR: 21.2, 95% CI: 1.9 to 236.0)ConclusionThe results are consistent with a relationship between tumor angiogenesis and prognostic factors for recurrence in early cervical cancer. "Abundant" vascularization and PI < 0.82 may be related to postoperative treatment due to risk factors.
Highlights
The aim of the present article was to evaluate whether angiogenic parameters as assessed by transvaginal color Doppler ultrasound (TVCD) may predict those prognostic factors related to recurrence
Prognostic factors prediction Receiver operating characteristics (ROC) curves showed that the best cut-off values for tumor diameter and depth of stromal invasion (DSI) for predicting postoperative treatment were 17.5 mm (AUC: 0.66, 95% CI: 0.41 to 0.91) and 10 mm (AUC: 0.78, 95% CI: 0.57 to 0.98), respectively
The amount of vascularization was significantly associated with prognostic factors: Tumors with "abundant" vascularization were significantly associated with pelvic lymph node (LN) metastases, DSI > 10 mm, lymph-vascular space invasion (LVSI), tumor diameter > 17.5 mm, and parametrial involvement (Table 2)
Summary
The aim of the present article was to evaluate whether angiogenic parameters as assessed by transvaginal color Doppler ultrasound (TVCD) may predict those prognostic factors related to recurrence. Angiogenesis has gained much attention in oncology in recent years. Several studies have demonstrated that tumor angiogenesis is an independent prognostic factor in cervical cancer [2,3,4]. Tumor angiogenesis can only be assessed on the surgical specimen after surgery and its prospective use, as part of the treatment plan is difficult. Transvaginal Color-Doppler Ultrasound (TVCD) allows an in vivo non-invasive and prospective assessment of tumor vascularization [5]. Some studies have shown that color and Power-Doppler sonography can be used to depict flow within arterioles and venules > 100 μm [6]. Recent developments in this field have enabled depiction of microvasculature (
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