Radical hysterectomy without adjuvant radiotherapy in patients with cervix carcinoma FIGO 2009 IB1, with or without positive Sedlis criteria.

Abstract

INTRODUCTION:

Lymphovascular space invasion (LVSI), deep (>1/3) stromal invasion (DSI) and large tumor size (>4 cm) have been identified as predictors for intermediate risk for recurrence according to Sedlis (at least two of the prior risk factors) in FIGO stage I cervical cancer. Adjuvant radiotherapy (RT) has been advocated in these patients(1,2), but remains controversial.

METHOD:

All consecutive patients (1997-2017) with cervical cancer FIGO (2009) stage IB1 (≤4 cm) were included. Primary aim was to analyze the recurrence rate. Secondary aim was to identify the risk factors for disease recurrence and survival.

RESULTS:

One-hundred-and-eighty-two patients were included in this retrospective study. Median follow-up was 13 years (range 8-17). Postoperatively, 21 patients received adjuvant therapy due to presence of positive lymph nodes, positive section margins or if a simple hysterectomy was performed (RT: n = 7, concomitant chemo radiotherapy (CCRT): n = 14). None of the patients with a combination of intermediate risk factors according to Sedlis (excluding patients >4 cm) underwent adjuvant RT/CCRT. Disease recurrence was observed in 19 patients (10%). Eleven patients died of disease. LVSI influenced progression-free survival (PFS) (HR 3.950, p = 0.0163) and disease-specific survival (DSS) (HR 4.637, p = 0.0497) significantly. However, the combination of LVSI, tumor size and DSI according to Sedlis did not influence overall survival (OS), DSS or PFS.

CONCLUSION:

Recurrence rate was low (10%), despite the fact that patients with intermediate risk factors according to Sedlis did not receive postoperative RT/CCRT. LVSI was the sole risk factor influencing PFS and DSS. Combinations of risk factors according to Sedlis did not predict worse outcome.

• Authors: Jolien Haesen, Rawand Salihi, Toon Van Gorp, Els Van Nieuwenhuysen, Sileny N Han, Melissa Christiaens, Anne-Sophie Van Rompuy, Lise Waumans, Patrick Neven, Ignace Vergote
• Journal: Gynecologic oncology (Gynecol Oncol) Vol. 162 Issue 3 Pg. 539-545 (09 2021) ISSN: 1095-6859 [Electronic] United States
• PMID: 34253389 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 Elsevier Inc. All rights reserved.

Topics

• Adult
• Female
• Humans
• Hysterectomy
• Lymph Node Excision
• Lymphatic Metastasis
• Middle Aged
• Neoplasm Invasiveness
• Neoplasm Recurrence, Local (pathology)
• Neoplasm Staging
• Progression-Free Survival
• Radiotherapy, Adjuvant
• Retrospective Studies
• Survival Rate
• Uterine Cervical Neoplasms (pathology, radiotherapy, surgery)