The Prognostic Role of Magnetic-Resonance-Imaging-Detected Corpus Invasion in Patients with Cervical Carcinoma Who Underwent Definitive or Adjuvant Pelvic Radiotherapy.

OBJECTIVES

In patients undergoing a radical hysterectomy, uterine corpus invasion worsens cervical cancer prognosis. However, the prognostic role of the invasion in locally advanced stages remains elusive. Due to the inadequacy of typical corpus biopsies, corpus invasion is diagnosed using magnetic resonance imaging (MRI). In this study, we investigated the prognostic role of MRI-detected uterine corpus invasion in patients undergoing radiotherapy for cervical cancer.

METHODS

This retrospective analysis involved 259 patients without extrapelvic metastases, diagnosed with FIGO 2009 stages IB-IVA cervical carcinoma from January 2011 to December 2020. The corpus invasion extent was classified as exocervical-confined (group 1), endocervical (group 2), or uterine corpus invasion (group 3). The rates of overall survival, cancer-specific survival, locoregional recurrence, para-aortic lymph node recurrence, and extrapelvic metastases after pelvic radiotherapy were analyzed. Kaplan-Meier and Cox regression analyses were used to determine recurrence-associated risks. Optimal risk stratification was predicted using a receiver operating characteristic curve with the area under the curve.

RESULTS

Groups 1, 2, and 3 included 66.0%, 18.9%, and 15.1% of patients, respectively. The 5-year para-aortic lymph node recurrence rates were 6.3%, 17.2%, and 34.2% ( < 0.001). Uterine corpus invasion was an independent factor for overall survival, cancer-specific survival, locoregional recurrence, extrapelvic metastases, and para-aortic lymph node recurrence. Including uterine corpus invasion in the risk stratification led to higher areas under the curve for overall survival, cancer-specific survival, locoregional recurrence, extrapelvic metastases, and para-aortic lymph node recurrence than using single parameters.

CONCLUSIONS

In cervical cancer, following pelvic radiotherapy, uterine corpus invasion is a significant prognostic factor. More-aggressive treatments such as extended-field radiotherapy, adjuvant chemotherapy, and immune checkpoint inhibitors as an alternative to standard pelvic radiotherapy with concurrent chemotherapy may be considered in these patients.