Güler Çekiç Sebile, Bulut Mehmet, Aldıkaçtıoğlu Talmaç Merve, Aydın Emine, Büyükkaya Öcal Emine Ufuk, Akça Aysu, Numanoğlu Ceyhun, Ülker Volkan, Akbayır Özgür
Koç University Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Türkiye.
Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Türkiye.
Turk J Obstet Gynecol. 2025 Sep 5;22(3):237-245. doi: 10.4274/tjod.galenos.2025.39969.
Radical hysterectomy with parametrectomy remains the standard treatment for early-stage cervical cancer but is associated with significant morbidity. Identifying patients at low risk for parametrial invasion is critical to support less invasive surgical strategies.
This retrospective study evaluated 177 patients with Federation of Gynecology and Obstetrics 2018 stage IA-IIB cervical cancer who underwent type III radical hysterectomy with lymphadenectomy between 2001 and 2020. Clinical and pathological data were analyzed to identify predictors of parametrial invasion.
Parametrial invasion was observed in 40 patients (22.6%). These patients were significantly older (mean age 56.05±11.16 vs. 49.21±10.80 years, p=0.013), and they were more likely to be postmenopausal. Parametrial invasion was associated with larger tumor size (35.10±13.72 mm vs. 24.15±13.50 mm), greater depth of stromal invasion (>10 mm), lymphovascular space invasion (LVSI), and lymph node metastases, (pelvic and paraaortic), all p<0.01. Bivariate logistic regression identified age ≥55 years [odds ratio (OR): 3.302 95% confidence interval (CI): 1.432-7.614, p=0.005], LVSI positivity [OR: 3.952 (95% CI: 1.641-9.518, p=0.002], and stromal invasion depth >10 mm [OR: 5.326 (95% CI: 2.157-13.153, p<0.001] as independent predictors of parametrial invasion.
Age ≥55, LVSI, and deep stromal invasion are significant independent risk factors for parametrial invasion. Careful evaluation of these parameters may guide the selection of patients suitable for less radical surgery, potentially reducing morbidity without compromising oncologic outcomes.
根治性子宫切除术加宫旁组织切除术仍是早期宫颈癌的标准治疗方法，但会带来显著的发病率。识别宫旁组织浸润低风险患者对于支持侵入性较小的手术策略至关重要。
这项回顾性研究评估了2001年至2020年间接受III型根治性子宫切除术加淋巴结清扫术的177例国际妇产科联盟2018年IA-IIB期宫颈癌患者。分析临床和病理数据以确定宫旁组织浸润的预测因素。
40例患者（22.6%）观察到宫旁组织浸润。这些患者年龄显著更大（平均年龄56.05±11.16岁对49.21±10.80岁，p=0.013），且更可能处于绝经后状态。宫旁组织浸润与更大的肿瘤大小（35.10±13.72毫米对24.15±13.50毫米）、更深的间质浸润（>10毫米）、淋巴管间隙浸润（LVSI）以及淋巴结转移（盆腔和腹主动脉旁）相关，所有p<0.01。二元逻辑回归确定年龄≥55岁[比值比（OR）：3.302，95%置信区间（CI）：1.432-7.614，p=0.005]、LVSI阳性[OR：3.952（95%CI：1.641-9.518，p=0.002]和间质浸润深度>10毫米[OR：5.326（95%CI：2.157-13.153，p<0.001]为宫旁组织浸润的独立预测因素。
年龄≥55岁、LVSI和深部间质浸润是宫旁组织浸润的重要独立危险因素。对这些参数进行仔细评估可能会指导选择适合进行不太激进手术的患者，有可能在不影响肿瘤学结果的情况下降低发病率。
