Bizzarri Nicolò, Biscione Antonella, Moro Francesca, Pedone Anchora Luigi, Catinella Valeria, Certelli Camilla, Teodorico Elena, Fagotti Anna, Fanfani Francesco, Kucukmetin Ali, Querleu Denis, Ferrandina Gabriella, Scambia Giovanni, Testa Antonia Carla
UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy.
Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Diagnostics (Basel). 2023 Feb 4;13(4):583. doi: 10.3390/diagnostics13040583.
The primary aim of the present study was to investigate the prognostic impact (defined as disease-free-DFS and overall survival-OS) of the ultrasound scan tumor parameters, patients' anthropometric parameters, and their combination in early-stage cervical cancer. The secondary aim was to assess the relation between ultrasound characteristics and pathological parametrial infiltration. This is a retrospective, single-center, observational cohort study. Consecutive patients with clinical FIGO 2018 stage IA1-IB2 and IIA1 cervical cancer who underwent preoperative ultrasound examination and radical surgery between 02/2012 and 06/2019 were included. Patients who underwent neo-adjuvant treatment, fertility sparing surgery, and pre-operative conization were excluded. Data from 164 patients were analyzed. Body mass index (BMI) ≤20 Kg/m ( < 0.001) and ultrasound tumor volume ( = 0.038) were related to a higher risk of recurrence. The ratios between ultrasound tumor volume and BMI, ultrasound tumor volume and height, and ultrasound largest tumor diameter and BMI were significantly related to a higher risk of recurrence ( = 0.011, = 0.031, and = 0.017, respectively). The only anthropometric characteristic related to a higher risk of death was BMI ≤20 Kg/m ( = 0.021). In the multivariate analysis, the ratio between ultrasound-measured largest tumor diameter and cervix-fundus uterine diameter (with 37 as the cut-off) was significantly associated with pathological microscopic parametrial infiltration ( = 0.018). In conclusion, a low BMI was the most significant anthropometric biomarker impairing DFS and OS in patients with apparent early-stage cervical cancer. The ratios between ultrasound tumor volume and BMI, ultrasound tumor volume and height, and ultrasound largest tumor diameter and BMI significantly affected DFS but not OS. The ratio between ultrasound-measured largest tumor diameter and cervix-fundus uterine diameter was related to parametrial infiltration. These novel prognostic parameters may be useful in pre-operative workup for a patient-tailored treatment in early-stage cervical cancer.
本研究的主要目的是探讨超声扫描肿瘤参数、患者人体测量参数及其组合对早期宫颈癌预后的影响（定义为无病生存期-DFS和总生存期-OS）。次要目的是评估超声特征与病理宫旁浸润之间的关系。这是一项回顾性、单中心观察性队列研究。纳入了2012年2月至2019年6月期间接受术前超声检查和根治性手术的国际妇产科联盟（FIGO）2018临床分期为IA1-IB2和IIA1期宫颈癌的连续患者。接受新辅助治疗、保留生育功能手术和术前锥切术的患者被排除。对164例患者的数据进行了分析。体重指数（BMI）≤20 Kg/m（<0.001）和超声肿瘤体积（=0.038）与较高的复发风险相关。超声肿瘤体积与BMI、超声肿瘤体积与身高、超声最大肿瘤直径与BMI之间的比值与较高的复发风险显著相关（分别为=0.011、=0.031和=0.017）。与较高死亡风险相关的唯一人体测量特征是BMI≤20 Kg/m（=0.021）。在多变量分析中，超声测量的最大肿瘤直径与宫颈-宫底子宫直径之比（以37为临界值）与病理显微镜下宫旁浸润显著相关（=0.018）。总之，低BMI是明显早期宫颈癌患者中损害DFS和OS的最显著人体测量生物标志物。超声肿瘤体积与BMI、超声肿瘤体积与身高、超声最大肿瘤直径与BMI之间的比值显著影响DFS，但不影响OS。超声测量的最大肿瘤直径与宫颈-宫底子宫直径之比与宫旁浸润有关。这些新的预后参数可能有助于早期宫颈癌患者个体化治疗的术前评估。
