J Gynecol Oncol.  2015 Oct;26(4):255-261. 10.3802/jgo.2015.26.4.255.

Pretreatment risk factors for parametrial involvement in FIGO stage IB1 cervical cancer

• Yamazaki H
• Todo Y
• Okamoto K
• Yamashiro
• Kato H

• KMID: 2345915
• DOI: http://doi.org/10.3802/jgo.2015.26.4.255

Abstract

OBJECTIVE
All patients with stage IB1 cervical cancer do not need to undergo parametrectomy. Some low-risk criteria for parametrial involvement (PI) have been proposed based on pathological findings. The aim of this study was to determine pretreatment risk factors for PI in stage IB1 cervical cancer.
METHODS
We retrospectively reviewed 115 patients with stage IB1 cervical cancer who underwent radical hysterectomy or radical trachelectomy. Magnetic resonance imaging (MRI) was performed and serum concentrations of squamous cell carcinoma antigen (SCC-Ag) and cancer antigen 125 (CA-125) were determined in all patients before initial treatment. The following pretreatment factors were investigated: histological variant, maximum tumor diameter, tumor volume (volume index), pelvic lymph node enlargement, and serum tumor markers. Logistic regression analysis was used to select the independent risk factors for PI.
RESULTS
Eighteen of the 115 patients (15.7%) were pathologically diagnosed with PI. Multivariate analysis confirmed the following independent risk factors for PI: MRI-based tumor diameter > or =25 mm (odds ratio [OR], 9.9; 95% confidence interval [CI], 2.1 to 48.1), MRI-based volume index > or =5,000 mm3 (OR, 13.3; 95% CI, 1.4 to 125.0), and positive serum tumor markers SCC-Ag > or =1.5 ng/mL or CA-125 > or =35 U/mL (OR, 5.7; 95% CI, 1.3 to 25.1). Of 53 patients with no risk factors for PI, none had PI.
CONCLUSION
Less radical surgery may become one of the treatment options for stage IB1 cervical cancer patients with MRI-based tumor diameter <25 mm, MRI-based volume index <5,000 mm3, and negativity for SCC-Ag and CA-125.

Keyword

Hysterectomy; Magnetic Resonance Imaging; Risk Factors; Tumor Burden; Tumor Markers, Biological; Uterine Cervical Neoplasms

MeSH Terms

Adult
Aged
Antigens, Neoplasm/metabolism
Biomarkers, Tumor/metabolism
Female
Humans
Hysterectomy/methods
Lymphatic Metastasis
Magnetic Resonance Imaging/methods
Middle Aged
Neoplasm Staging
Observer Variation
Retrospective Studies
Risk Factors
Serpins/metabolism
Uterine Cervical Neoplasms/metabolism/*pathology/surgery
Young Adult
Antigens, Neoplasm
Biomarkers, Tumor
Serpins

Figure

• 

  Fig. 1 (A) Receiver operating characteristic (ROC) curves of tumor diameter, volume index, and serum tumor markers (SCC-Ag and CA-125) for predicting parametrial involvement (PI). (B) ROC curve of combination of tumor diameter, volume index, and serum tumor markers for predicting PI.

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