Nomogram Predicting the Likelihood of Parametrial Involvement in Early-Stage Cervical Cancer: Avoiding Unjustified Radical Hysterectomies.

Louise Benoit,Helene Bonsang-Kitzis,Charlotte Ngô,Patrice Mathevet,Laurent Magaud,Arnaud Bresset,Benedetta Guani,Fabrice Lécuru,Vincent Balaya

doi:10.3390/jcm9072121

Abstract

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: 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: 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: 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.

Highlights

Radical hysterectomy with pelvic node assessment is the standard treatment in early-stage cervical cancer
The resection of the parametrium is of primary importance in early stage cervical cancer, since it may be the main site of disease recurrences [10]
We aimed to develop a simple tool to predict parametrial involvement in early-stage cervical cancer and define a low-risk group of patients who would least benefit from a parametrectomy by integrating simple clinicopathologic factors and sentinel lymph node (SLN) status

Summary

Introduction

Radical hysterectomy with pelvic node assessment is the standard treatment in early-stage cervical cancer. Radical hysterectomy presents a high surgical morbidity due to extensive ureteral and nerve dissection [7]. They may be responsible for post-operative complications, such as bladder or bowel dysfunction, urinary tract fistula and urinary tract injury [8,9]. 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. 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. 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

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Discussion

Conclusion