Can parametrectomy be avoided in early cervical cancer? An algorithm for the identification of patients at low risk for parametrial involvement

Gemer, Ofer; Eitan, Ram; Gdalevich, Michael; Mamanov, Ala; Piura, Benjamin; Rabinovich, Alex; Levavi, Hanoch; Saar-Ryss, Bozhena; Halperin, Reuvit; Finci, Shahar; Beller, Uziel; Bruchim, Ilan; Levy, Tally; Shachar, Inbar Ben; Arie, Alon Ben; Lavie, Ofer

doi:10.1016/j.ejso.2012.10.013

Cited by 44 publications

(35 citation statements)

References 17 publications

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“…More recent studies estimated the rate of parametrial involvement in patients with clinical early-stage cervical cancer at 4-11% [11,12]. However, the parametrial involvement was detected in 41 (32.5%) patients in our study.…”

Section: Discussioncontrasting

confidence: 53%

“…In our study, we found that LVSI, deep cervical stromal invasion, lymph node metastasis, and tumor size are significant risk factors for parametrial involvement in patients with clinical early-stage cervical cancer. Likewise, O. Gemer et al, detected similar risk factors for parametrial involvement, including tumor size, depth of invasion, LVSI, and positive lymph nodes [11]. These authors suggested an algorithm for patients with early-stage cervical cancer.…”

Section: Discussionmentioning

confidence: 96%

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Clinical and pathological characteristics related to parametrial involvement in clinical early-stage cervical cancer

Boyraz

Başaran²,

Salman³

et al. 2016

Ginekol Pol

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Objectives: Since parametrial involvement is believed to be a crucial factor in the management of cervical cancer, our study was designed to investigate the clinical and pathological features which predicted parametrial involvement in patients with clinical early-stage cervical cancer. Material and methods:The study included patients with clinical early-stage cervical cancer who underwent radical hysterectomy with pelvic and para-aortic lymphadenectomy between December 2001 and August 2014, at the Hacettepe University Hospital. The clinical and pathological characteristics of the affected patients were evaluated, including age, histologic subtype, tumor size, depth of cervical stromal invasion, lympho-vascular space invasion (LVSI), and lymph node metastasis. Univariate and multivariate analyses were performed to reveal factors associated with parametrial involvement. Results:The study group consisted of 126 patients (mean age: 52.7 years; range: 29-83), including 101 (80.2%) with squamous, 19 (15.1%) with adenocarcinoma, and 6 (4.8%) with adenosquamous histological subtype of cervical cancer. Parametrial involvement and lymph node metastasis were detected in 41 (32.5%) and 46 (36.5%) women, respectively. Univariate analysis showed that deep cervical stromal invasion, LVSI, tumor size > 2 cm and lymph node metastasis were associated with parametrial involvement. Multivariate logistic regression analysis identified the independent risk factors associated with parametrial involvement as LVSI (OR 8.93, 95% CI 1.1-73.5, p = 0.042) and lymph node metastasis (OR 8.8, 95% CI 1.5-9.3, p = 0.004).Conclusions: LVSI, deep cervical stromal invasion, lymph node metastasis and tumor size are significantly associated with parametrial involvement in patients with clinical early-stage cervical cancer.

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 96%

Clinical and pathological characteristics related to parametrial involvement in clinical early-stage cervical cancer

Boyraz

Başaran²,

Salman³

et al. 2016

Ginekol Pol

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“…Several published papers have reported that PI in early-stage cervical cancer is uncommon with incidences varying between 4 and 11% [5,6,7,8,9,10,16,18]. In the present study, we found PI in 4.25% of patients with cervical cancer stages IA2-IB1, which is at the lower end of the range seen in previous studies [4,7], probably because the majority of our patients had a small tumor size compared to some studies that included larger, IB2 (bulky) tumors (and IIA in some series) and cited a higher rate of PI [5,9].…”

Section: Discussionmentioning

confidence: 99%

“…These studies found that patients with favorable prognostic factors such as tumor size ≤ 2cm, no LVSI, no DSI, and no lymph node metastasis had a very low risk for PI [9,11,12,13,14,15,16]. However, the selection criteria for omission of parametrial resection in early-stage cervical cancer are inconsistent [9,10,12,13,14,15,16]. …”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the rationale for parametrectomy (resection of the parametrium) is to remove occult disease at the time of extirpation of the primary cervical cancer. Previous published studies found that the incidence of parametrial involvement (PI) of early-stage cervical cancer was 4-11% [5,6,7,8,9,10]. In 1995, Kinney et al [10] evaluated 387 stage IB squamous cell cancer patients treated with radical surgery.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Parametrial Involvement in Early-Stage Cervical Cancer and Identification of Patients Suitable for Less Radical Surgery

Jiamset

Hanprasertpong²

2016

Oncol Res Treat

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Background: The aim of this study was to determine risk factors associated with parametrial involvement (PI) and to identify the subgroup of patients at low risk for PI. Methods: The study comprised 565 patients with early-stage cervical cancer, who underwent radical hysterectomy with pelvic node dissection at Songklanagarind Hospital between 1987 and 2011. Analysis was performed to determine factors associated with PI. Results: Overall, 24 (4.25%) women had PI. PI was more common in patients with non-squamous cell carcinoma, deep stromal invasion (DSI), tumor size > 2 cm, lymphovascular space invasion (LVSI), and pelvic node involvement. Multivariate analysis showed that DSI (p < 0.001) and tumor size > 2 cm (p < 0.001) were independently associated with PI. PI was linked with decreased recurrence-free (p < 0.001) and overall (p = 0.002) survival. Of 347 patients with tumor size ≤ 2 cm and no DSI, only 1 (0.29%) had PI. Conclusion: These findings confirm that PI in early-stage cervical cancer is uncommon. Risk factors associated with PI were DSI and tumor size > 2 cm. PI is a predictor of cervical cancer recurrence and decreased survival. Less radical surgery may be considered in low-risk patients.

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Radical Vaginal Trachelectomy

Köhler

Favero

Schneider³

2017

Hysterectomy

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Can parametrectomy be avoided in early cervical cancer? An algorithm for the identification of patients at low risk for parametrial involvement

Cited by 44 publications

References 17 publications

Clinical and pathological characteristics related to parametrial involvement in clinical early-stage cervical cancer

Clinical and pathological characteristics related to parametrial involvement in clinical early-stage cervical cancer

Risk Factors for Parametrial Involvement in Early-Stage Cervical Cancer and Identification of Patients Suitable for Less Radical Surgery

Radical Vaginal Trachelectomy

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