Abstract
Objective: This study aimed to estimate the incidence of PI in patients with early-stage CC and establish a simple nomogram to identify a cohort of patients with low risk of PI who may benefit from less radical surgery. Methods: All patients who underwent radical hysterectomy and pelvic lymphadenectomy were included from 2013 to 2018. The significant independent predictors were identified through Cox regression analysis and then incorporated into a nomogram to predicate PI. The calibration plots and receiver operating characteristic (ROC) curves for assessing the predictive accuracy of the nomogram. Findings: Of 4533 patients met the inclusion criteria, 441 women (9.7%) had PI. The positive PI rate in the less than equal to 2 cm group (1.2%) was significantly lower than in greater than 2-less than equal to 4 cm (6.2%) or greater than 4 cm (22.4%) groups. Multivariate analyses revealed that tumor size (P=0.002), lymph vascular space invasion (LVSI) (P=0.001), vaginal involvement (VI) (P<0.001), statue of pelvic lymph nodes (PLN) (P=0.001), and depth of stromal invasive (DSI) (P<0.001), were independent prognostic factors of PI. Finally, five variables were combined to construct nomogram model. The concordance indexes (C-indexes) of PI were 0.756 (95% CI, 0.726-0.786) for the internal validation and 0.729 (95% CI, 0.678-0.780) for the external validation. Calibration plots further showed good consistency between the nomogram prediction and actual observation. Interpretation: This nomogram based on significant clinicopathological characteristics provided a reliable tool for clinicians to predict PI among early-stage CC patients, who might benefit a less radical surgery. Funding: Funding: The Clinical Research Plan of SHDC (SHDC2020CR1045B) to Keqin Hua; Shanghai Municipal Health commission (20194Y0085) to Chunbo Li; The Shanghai “Rising Stars of Medical Talent” Youth Development Program (SHWSRS2020087) to Chunbo Li. Declaration of Interest: Ethical Approval: This study was approved from the Medical Ethics Committee of our hospital.
Highlights
Radical hysterectomy (RH) with pelvic lymphadenectomy has become the surgical standard for the treatment of the earlystage cervical cancer (CC) [1]
According to the Cox regression analysis, the parametrial involvement (PI) was strongly associated with tumor size (p = 0.002), the presence of lymphovascular space invasion (LVSI) (p < 0.001), vaginal involvement (p < 0.001), depth of stromal invasion (DSI) ≥ 50% (p < 0.001), and positive pelvic lymph nodes (PLNs) (p < 0.001) (Table 4)
Tumor size, LVSI, DSI, vaginal invasion (VI), and the status of PLN were all related to the occurrence of the PI (Figure 4)
Summary
Radical hysterectomy (RH) with pelvic lymphadenectomy has become the surgical standard for the treatment of the earlystage cervical cancer (CC) [1]. The procedure requires en bloc resection of the uterus and cervix along with the surrounding parametria to remove any micrometastatic lesions that have spread from the cervix [2]. Parametrectomy is the most difficult step of the RH and is generally considered as the main source of substantial complications. The occurrence of the complications can be attributed to the parametrial resection as part of the RH [3]. Some surgeons advocate a “nerve-sparing” technique that may minimize the occurrence of these complications, but the technique requires a specific learning curve and high surgical skills before being generalized [5, 6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
