Hwang Woo Yeon, Kim Ju-Hyun, Suh Dong Hoon, Kim Kidong, No Jae Hong, Kim Yong Beom
Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
Int J Gynecol Cancer. 2020 Jul;30(7):975-980. doi: 10.1136/ijgc-2020-001271. Epub 2020 May 28.
Patients who undergo radical hysterectomy may require postoperative adjuvant radiotherapy, and all efforts should be made to reduce dual therapy in such patients. The aim of this study was to determine the optimal upper limit of tumor size in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB2 cervical cancer who undergo radical hysterectomy.
We retrospectively reviewed the records of 114 patients with FIGO 2018 stage IB2 cervical cancer who underwent primary surgery either with (n=55) or without (n=59) adjuvant radiotherapy from June 2004 to December 2018. The inclusion criteria were as follows: women diagnosed with stage IB2 cervical cancer; primary radical surgery with pelvic lymph node dissection with or without para-aortic lymph node dissection; and patients treated with or without postoperative adjuvant radiation therapy, concurrent chemoradiation therapy, or chemotherapy. A receiver operating characteristic (ROC) curve analysis was used to determine the optimal tumor size cut-off value. The optimal tumor size cut-off value was determined by the maximum sum of sensitivity and specificity.
There were 55 and 59 patients treated with or without adjuvant therapy, respectively, after radical hysterectomy. Age, histologic type, and pelvic and para-aortic lymph node sampling/dissection status were similar between each group. The number of patients with a tumor size <2.7 cm and ≥2.7 cm was 39 and 75, respectively. The decision for adjuvant treatment after radical hysterectomy in patients with stage IB2 cervical cancer was influenced by intermediate risk factors (lymphovascular space invasion, 23.7% vs 76.4%, p<0.001; deep 1/3 of invasion, 16.9% vs 61.8%, p<0.001) and high risk factors (lymph node metastasis, 0% vs 40.0%, p<0.001; involvement of parametrium, 1.7% vs 16.4%, p=0.007). According to the ROC curve results considering the best sensitivity and specificity, the optimal cut-off value of tumor size for predicting adjuvant treatment was 2.7 cm (sensitivity 0.85, specificity 0.52). The number of patients with a tumor size <2.7 cm and ≥2.7 cm was 39 (34.2%) and 75 (65.8%), respectively. No significant differences were observed in the progression-free survival (p=0.22) and overall survival (p=0.28) rates between tumor size smaller than 2.7 cm and larger than 2.7 cm.
A cervical tumor larger than 2.7 cm before radical surgery in stage IB2 may predispose to potential complications from combining radical hysterectomy and concurrent chemoradiation,. We consider that concurrent chemoradiation therapy is a more appropriate choice for tumor size over 2.7 cm per the revised FIGO 2018 criteria for stage IB2 cervical cancer.
接受根治性子宫切除术的患者可能需要术后辅助放疗，应尽一切努力减少此类患者的双重治疗。本研究的目的是确定接受根治性子宫切除术的国际妇产科联盟（FIGO）IB2期宫颈癌患者肿瘤大小的最佳上限。
我们回顾性分析了2004年6月至2018年12月期间114例FIGO 2018期IB2期宫颈癌患者的记录，这些患者接受了初次手术，其中55例接受了辅助放疗，59例未接受辅助放疗。纳入标准如下：确诊为IB2期宫颈癌的女性；进行盆腔淋巴结清扫术及有无腹主动脉旁淋巴结清扫术的原发性根治性手术；接受或未接受术后辅助放疗、同步放化疗或化疗的患者。采用受试者工作特征（ROC）曲线分析来确定最佳肿瘤大小截断值。最佳肿瘤大小截断值由敏感性和特异性的最大总和确定。
根治性子宫切除术后，分别有55例和59例患者接受或未接受辅助治疗。每组患者的年龄、组织学类型以及盆腔和腹主动脉旁淋巴结取样/清扫情况相似。肿瘤大小<2.7 cm和≥2.7 cm的患者数量分别为39例和75例。IB2期宫颈癌患者根治性子宫切除术后辅助治疗的决策受中级风险因素（淋巴管间隙浸润，23.7%对76.4%，p<0.001；深部1/3浸润，16.9%对61.8%，p<0.001）和高级风险因素（淋巴结转移，0%对40.0%，p<0.001；宫旁组织受累，1.7%对16.4%，p=0.007）影响。根据考虑最佳敏感性和特异性的ROC曲线结果，预测辅助治疗的肿瘤大小最佳截断值为2.7 cm（敏感性0.85，特异性0.52）。肿瘤大小<2.7 cm和≥2.7 cm的患者数量分别为39例（34.2%）和75例（65.8%）。肿瘤大小小于2.7 cm和大于2.7 cm的患者在无进展生存期（p=0.22）和总生存期（p=0.28）方面未观察到显著差异。
IB2期根治性手术前宫颈肿瘤大于2.7 cm可能易因根治性子宫切除术和同步放化疗联合而引发潜在并发症。根据修订后的FIGO 2018 IB2期宫颈癌标准，我们认为同步放化疗是肿瘤大小超过2.7 cm时更合适的选择。
