Pan Teresa L, Pareja Rene, Chiva Luis, Rodriguez Juliana, Munsell Mark F, Iniesta Maria D, Manzour Nabil, Frumovitz Michael, Ramirez Pedro T
Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Tirol, Austria
Gynecology, Gynecologic Oncology, Clinica ASTORGA, Medellin, and Instituto Nacional de Cancerología, Bogotá, Colombia, Medellin, Colombia.
Int J Gynecol Cancer. 2024 Dec 2;34(12):1861-1866. doi: 10.1136/ijgc-2024-005986.
The primary aim of our study was to compare tumor size assessment by pre-operative evaluation (physical examination and/or imaging) with tumor size on final pathology. As a secondary outcome, we evaluated the rate of adjuvant treatment in patients who underwent radical hysterectomy whose tumor size was ≥3 cm on final pathology.
Patient details were collected from three separate databases: the University of Texas MD Anderson Cancer Center Radical Hysterectomy Database, the SUCCOR Study Group Database, and the Multi-institutional Database LATAM (encompassing Latin America and Europe). Patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IB2 cervical cancer on pre-operative evaluation (physical examination or imaging) who underwent radical hysterectomy with a therapeutic intent were included. Any histological subtype, any tumor grade, and pre-operative evaluation with clinical evaluation and/or imaging (ultrasound, MRI, CT, or PET/CT) was considered.
A total of 675 patients met eligibility criteria (SUCCOR=350, LATAM=250, MD Anderson=75). The median age was 46 years (range 22-82) and the median body mass index was 25.6 kg/m (range 15.1-68). The most common histologic subtype was squamous carcinoma (68%, n=456), and the majority had either grade 2 or 3 disease . Overall pre-operative imaging modalities used were MRI (52%, n=352), ultrasound (21%, n=140), CT (5%, n=32), and PET/CT (1%, n=10). Most patients underwent open surgery (60%, n=404). In total, 113 (17%) patients had lymph node involvement and 58 (9%) patients had parametrial involvement. A total of 343 (51%) patients received adjuvant therapy, with the majority of those receiving chemoradiation (54%, n=186) followed by radiation alone (44%, n=152). The results of the Bland-Altman analysis showed that pre-operative physical examination, MRI, ultrasound, and CT all overestimated tumor size, but only the bias found for physical examination (p<0.0001) and MRI (p=0.0102) were statistically significant. However, in patients who underwent a pre-operative MRI, a total of 293 (83.2%) patients with tumor size 2-4 cm by MRI had concordance with tumor measurement on final pathology. Similarly, when evaluating accuracy of physical examination with tumor size by MRI, we found that there was agreement in 319 (91.1%) patients. Similarly, we found that concordance of physical examination with tumor size on final pathology was 80.6%. There were 340 (50%) patients who had tumor size on pathology ≥3 cm, and 207 (61%) of these received adjuvant therapy. Additionally, there was a significantly higher incidence of positive lymph nodes with increasing tumor size on pathology (2-2.99 cm, 13% (29/222) vs 3-4 cm, 21% (66/316), p=0.022).
Our study showed that there is a high concordance between tumor size assessment by physical examination and MRI, as well as estimates of measurement by MRI and final pathology. In addition, we noted that the majority of patients with FIGO 2018 stage IB2 received adjuvant therapy after radical hysterectomy.
我们研究的主要目的是比较术前评估（体格检查和/或影像学检查）得出的肿瘤大小与最终病理检查的肿瘤大小。作为次要结果，我们评估了最终病理检查肿瘤大小≥3 cm且接受根治性子宫切除术患者的辅助治疗率。
从三个独立数据库收集患者详细信息：德克萨斯大学MD安德森癌症中心根治性子宫切除术数据库、SUCCOR研究组数据库和多机构数据库LATAM（涵盖拉丁美洲和欧洲）。纳入术前评估（体格检查或影像学检查）为国际妇产科联盟（FIGO）2018年IB2期宫颈癌且接受根治性子宫切除术的患者。考虑任何组织学亚型、任何肿瘤分级以及采用临床评估和/或影像学检查（超声、MRI、CT或PET/CT）进行的术前评估。
共有675例患者符合纳入标准（SUCCOR组350例，LATAM组250例，MD安德森组75例）。中位年龄为46岁（范围22 - 82岁），中位体重指数为25.6 kg/m²（范围15.1 - 68）。最常见的组织学亚型是鳞状细胞癌（68%，n = 456），大多数患者为2级或3级疾病。总体术前使用的影像学检查方式为MRI（52%，n = 352）、超声（21%，n = 140）、CT（5%，n = 32）和PET/CT（1%，n = 10）。大多数患者接受开放手术（60%，n = 404）。共有113例（占17%）患者有淋巴结受累，58例（占9%）患者有宫旁组织受累。共有343例（占51%）患者接受辅助治疗，其中大多数接受同步放化疗（54%，n = 186），其次是单纯放疗（44%，n = 152）。Bland - Altman分析结果显示，术前体格检查、MRI、超声和CT均高估了肿瘤大小，但仅体格检查（p < 0.0001）和MRI（p = 0.0102）的偏差具有统计学意义。然而，在接受术前MRI检查的患者中，MRI显示肿瘤大小为2 - 4 cm的患者共有293例（占83.2%），其肿瘤大小与最终病理测量结果一致。同样，在通过MRI评估体格检查与肿瘤大小的准确性时，我们发现319例（占91.1%）患者结果一致。同样，我们发现体格检查与最终病理检查的肿瘤大小一致性为80.6%。病理检查肿瘤大小≥3 cm的患者有340例（占50%），其中207例（占61%）接受了辅助治疗。此外，病理检查肿瘤大小增加时，阳性淋巴结的发生率显著更高（2 - 2.99 cm，13%（29/222） vs 3 - 4 cm，21%（66/316），p = 0.022）。
我们的研究表明，体格检查和MRI对肿瘤大小的评估之间、MRI测量结果与最终病理检查之间具有高度一致性。此外，我们注意到大多数FIGO 2018年IB2期患者在根治性子宫切除术后接受了辅助治疗。
