Pathologic and clinical tumor size discordance in early-stage cervical cancer: Does it matter?

Autor: Vetter MH; The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States., Smrz S; The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States., Gehrig PA; University of North Carolina Gynecologic Oncology, Chapel Hill, NC, United States., Peng K; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States., Matsuo K; University of Southern California Keck School of Medicine, Los Angeles, CA, United States., Davidson BA; Duke University, Durham, NC, United States., Cisa MP; Duke University, Durham, NC, United States., Lees BF; University of Wisconsin, Madison, WI, United States., Brunette LL; University of Southern California Keck School of Medicine, Los Angeles, CA, United States., Tucker K; University of North Carolina Gynecologic Oncology, Chapel Hill, NC, United States., Stuart Staley A; University of North Carolina Gynecologic Oncology, Chapel Hill, NC, United States., Gotlieb WH; McGill University, Montreal, Quebec, Canada., Holloway RW; AdventHealth Medical Group GYN Oncology, Orlando, FL, United States., Essel KG; University of Oklahoma, Norman, OK, United States., Holman LL; University of Oklahoma, Norman, OK, United States., Goldfeld E; University of Pittsburgh, Pittsburgh, PA, United States., Olawaiye A; University of Pittsburgh, Pittsburgh, PA, United States., Rose S; University of Wisconsin, Madison, WI, United States., Uppal S; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States., Bixel K; The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States. Electronic address: Kristin.bixel@osumc.edu.
Jazyk: angličtina
Zdroj: Gynecologic oncology [Gynecol Oncol] 2020 Nov; Vol. 159 (2), pp. 354-358. Date of Electronic Publication: 2020 Sep 02.
DOI: 10.1016/j.ygyno.2020.08.004
Abstrakt: Objective: The objective of this study was to assess the rate of discordance between clinical and pathologic tumor size for women with stage IB1 cervical cancer (FIGO 2009 criteria), assess risk factors for discordance, and determine the impact of discordance on oncologic outcomes.
Methods: This was a secondary analysis of a prior multi-institutional retrospective review of patients diagnosed with stage IB1 (FIGO 2009 staging) cervical cancer undergoing radical hysterectomy between 2010 and 2017. Demographic, clinicopathologic, and oncologic data were collected. Pathologic upstaging was defined as having a preoperative diagnosis of stage IB1 cervical cancer with pathology demonstrating a tumor size >4 cm. Demographic and clinicopathologic data was compared using chi-square, fisher exact or 2-sided t-test. Survival was estimated using the Kaplan-Meier method.
Results: Of the 630 patients, 77 (12%) were upstaged. Patients who were upstaged had lower rates of preoperative conization (p < .001) or preoperative tumor sizes ≤2 cm (p < .001). Upstaged patients had increased odds of deep stromal invasion, lymphovascular space invasion, positive margins and positive lymph nodes. Almost 88% of upstaged patients received adjuvant therapy compared to 29% of patients with tumors ≤4 cm (odds 18.49, 95% CI 8.99-37.94). Finally, pathologic upstaging was associated with an increased hazard of recurrence (hazard ratio [HR] 1.95, 95% CI 1.03-3.67) and all-cause death (HR 2.31, 95% CI 1.04-5.11).
Conclusions: Pathologic upstaging in stage IB1 cervical cancer is relatively common. Upstaging is associated with an 18-fold increased risk of receipt of adjuvant therapy. Patients undergoing preoperative conization and those with tumors <2 cm had lower risks of upstaging. Improvement in preoperative assessment of tumor size may better inform primary treatment decisions.
Competing Interests: Declaration of Competing Interest The authors of this manuscript have no conflicts of interest to disclose.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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