Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Fondazione Policlinico Universitario A. Gemelli IRCCS, Research core facility Data Collection G-STeP, Rome, Italy.
Eur Radiol. 2024 Jun;34(6):4003-4013. doi: 10.1007/s00330-023-10443-3. Epub 2023 Nov 20.
This retrospective observational study aims to evaluate the association between the extent of parametrial invasion (PMI) and disease-free survival (DFS) and cancer-specific survival (CSS) in patients with locally advanced cervical cancer (LACC).
This study included patients with LACC showing parametrial invasion at Magnetic Resonance Imaging (MRI). They were treated with neoadjuvant chemo-radiotherapy (CT/RT) before undergoing radical hysterectomy. The staging MRIs were reviewed retrospectively. Measurements of maximum PMI (PMI) and parametrial length were taken bilaterally. After that, PMI was calculated by dividing PMI by parametrial length. Analysis was conducted on homogeneous subsets of patients, grouped based on their pathological lymph nodal evaluation (N- and N+). Correlations between PMI and PMI with DFS and CSS were evaluated in both the N- and N+ groups, employing univariable Cox regression analysis.
Out of 221 patients, 126 (57%) had non-metastatic lymph nodes (N-), while 95 (43%) had metastatic lymph nodes (N+). The median observation period for all these patients was 73 months (95% confidence interval [CI]: 66-77). The 5-year DFS and CSS probability rates were 75% and 85.7%, respectively, for the N- group and 54.3% and 73.6%, respectively, for the N+ group. A higher PMI (hazard ratio [HR] = 1.09) and PMI (HR = 1.04) correlated with worse overall survival in patients in the N- group (p = 0.025 and p = 0.042). These parameters did not show a significant statistical association in the N+ group.
The degree of PMI evaluated on MRI affects outcome in N- patients with LACC.
The degree of MRI parametrial invasion affects disease-free survival and cancer-specific survival in patients with the International Federation of Gynecology and Obstetrics (FIGO) stage IIB cervical cancer. This MRI finding can be easily incorporated into routine clinical practice.
• Visual assessment of parametrial invasion on MRI was not significantly associated with prognosis in locally advanced cervical cancer (LACC). • A greater degree of parametrial invasion is associated with poorer disease-free survival and cancer-specific survival in patients with LACC without metastatic lymph node involvement. • The degree of parametrial invasion at MRI has no correlation with prognosis in LACC with metastatic lymph nodes.
本回顾性观察研究旨在评估局部晚期宫颈癌（LACC）患者宫旁侵犯程度（PMI）与无病生存（DFS）和癌症特异性生存（CSS）之间的关系。
本研究纳入了 MRI 显示宫旁侵犯的 LACC 患者。他们在接受根治性子宫切除术前行新辅助放化疗（CT/RT）。回顾性审查分期 MRI。双侧测量最大 PMI（PMI）和宫旁长度。然后，通过将 PMI 除以宫旁长度来计算 PMI。根据病理淋巴结评估（N-和 N+）将患者分为同质亚组进行分析。在 N-和 N+组中，采用单变量 Cox 回归分析评估 PMI 与 DFS 和 CSS 的相关性。
在 221 名患者中，126 名（57%）患者无转移性淋巴结（N-），95 名（43%）患者有转移性淋巴结（N+）。所有这些患者的中位观察期为 73 个月（95%置信区间 [CI]：66-77）。N-组的 5 年 DFS 和 CSS 概率分别为 75%和 85.7%，N+组分别为 54.3%和 73.6%。在 N-组中，较高的 PMI（风险比 [HR] = 1.09）和 PMI（HR = 1.04）与总体生存率较差相关（p = 0.025 和 p = 0.042）。这些参数在 N+组中没有显示出统计学上的显著关联。
MRI 上评估的 PMI 程度影响 LACC 中 N-患者的结局。
国际妇产科联合会（FIGO）分期 IIB 宫颈癌患者 MRI 宫旁侵犯程度影响无病生存率和癌症特异性生存率。这种 MRI 发现可以很容易地纳入常规临床实践。
• MRI 上宫旁侵犯的视觉评估与局部晚期宫颈癌（LACC）的预后无显著相关性。• 宫旁侵犯程度较大与无转移性淋巴结受累的 LACC 患者无病生存率和癌症特异性生存率较差相关。• MRI 上宫旁侵犯程度与转移性淋巴结的 LACC 患者的预后无相关性。
