Benoit Louise, Balaya Vincent, Guani Benedetta, Bresset Arnaud, Magaud Laurent, Bonsang-Kitzis Helene, Ngô Charlotte, Mathevet Patrice, Lécuru Fabrice
Faculty of Medicine, Paris University, 75006 Paris, France.
Gynecology Department, Centre Hospitalo-Universitaire Vaudois, 1011 Lausanne, Switzerland.
J Clin Med. 2020 Jul 5;9(7):2121. doi: 10.3390/jcm9072121.
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.
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.
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%.
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.
我们旨在建立一种预测早期宫颈癌患者宫旁组织受累（PI）的工具，并筛选出最能从较不根治性手术中获益的患者亚组。
我们回顾性分析了2005年至2012年来自两个前瞻性多中心数据库SENTICOL I和II的患者。纳入早期宫颈癌（国际妇产科联盟（FIGO）2018年分期为IA期伴淋巴血管浸润至IIA1期）、接受根治性手术（子宫切除术或宫颈锥切术）且双侧前哨淋巴结（SLN）定位、术前影像学检查无转移淋巴结或PI的患者。
共有5.2%的患者（11/211）出现组织学PI。单因素分析后，SLN状态、淋巴血管间隙浸润、深部间质浸润和肿瘤大小与PI显著相关，并纳入我们的列线图。我们的预测模型曲线下面积（AUC）为0.92（95%置信区间（IC95%）=0.86 - 0.98），校准良好。根据最佳敏感性和特异性定义的低风险组，PI的预测概率为2%。
患者可从两步法中获益。最终手术（即根治性手术和/或淋巴结清扫术）将取决于SLN状态以及初次锥切术联合双侧SLN定位后计算出的PI概率。
