Risk factors for lymph node metastasis in women with FIGO 2018 IA cervical cancer with a horizontal spread of > 7 mm

IF 7.6 1区 医学 Q1 ONCOLOGY European Journal of Cancer Pub Date : 2024-10-05 DOI:10.1016/j.ejca.2024.115063
Hans H.B. Wenzel , Tine H. Schnack , Maaike A. Van der Aa , Pernille T. Jensen , Claus K. Høgdall , Anna Norberg Hardie , Henrik Falconer , Ruud L.M. Bekkers , Dutch, dANish and sweDish gynaEcoLogIcal ONcology (DANDELION) research group
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Abstract

Background

In the FIGO 2018 classification, women with cervical cancer and a depth of invasion ≤ 5 mm and a horizontal spread of > 7 mm in excisional biopsy with tumour-free margins, are now classified as stage IA instead of IB. This stage shift may reduce the likelihood of surgical lymph node staging. It is therefore crucial to estimate the risk and risk factors of lymph node metastasis (pN+) in this group.

Methods

Women diagnosed with cervical cancer between 2005 and 2022 were identified from nationwide population-based registries from the Netherlands, Denmark, and Sweden. Inclusion criteria were squamous cell carcinoma or adenocarcinoma, FIGO 2009 stage IB1, a depth of invasion ≤ 5 mm and horizontal spread of > 7–≤ 40 mm. All cases underwent radical hysterectomy or radical trachelectomy, and surgical lymph node staging. Logistic regression was used to identify risk factors of pN+.

Results

We included 992 women (pN+ 4.1 %; n = 41). Lymphovascular space invasion (LVSI) was a significant risk factor of pN+ (odds ratio 4.26, 95 % confidence interval 2.24–8.32). Accordingly, the risk of pN+ was ≥ 7.3 % in LVSI-positive tumours. The risk was lowest in LVSI-negative tumours with a size of > 7–≤ 20 mm (2.2 %), although this varied by depth of invasion and histological subtype (pN+ range 0.6–5.1 %).

Conclusion

Women with LVSI-positive FIGO 2018 IA cervical cancer and a horizontal spread > 7 mm, should undergo surgical lymph node staging. In LVSI-negative tumours, lymph node staging should not be routinely performed; tumour size, depth of invasion and histology should be considered.
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患有 FIGO 2018 IA 宫颈癌且水平扩散范围大于 7 毫米的妇女发生淋巴结转移的风险因素。
背景:在 FIGO 2018 分级中,患有宫颈癌且在切除活检中浸润深度≤5 毫米、水平扩散>7 毫米且边缘无肿瘤的女性,现在被归类为 IA 期而非 IB 期。这种分期的转变可能会降低手术淋巴结分期的可能性。因此,估算该群体淋巴结转移(pN+)的风险和风险因素至关重要:方法:从荷兰、丹麦和瑞典的全国性人口登记中筛选出 2005 年至 2022 年期间确诊为宫颈癌的女性。纳入标准为:鳞状细胞癌或腺癌、FIGO 2009 IB1 期、浸润深度≤ 5 毫米且水平扩散 > 7-≤ 40 毫米。所有病例均接受了根治性子宫切除术或根治性气管切除术,并进行了手术淋巴结分期。采用逻辑回归确定pN+的风险因素:我们共纳入992名妇女(pN+ 4.1 %;n = 41)。淋巴管间隙侵犯(LVSI)是pN+的重要风险因素(几率比4.26,95%置信区间2.24-8.32)。因此,LVSI阳性肿瘤的pN+风险≥7.3%。LVSI阴性、大小> 7-≤ 20 mm的肿瘤的pN+风险最低(2.2%),但这一风险因浸润深度和组织学亚型而异(pN+范围为0.6-5.1%):结论:LVSI阳性的FIGO 2018 IA宫颈癌患者,水平扩散范围大于7毫米,应进行手术淋巴结分期。对于LVSI阴性的肿瘤,不应常规进行淋巴结分期;应考虑肿瘤大小、浸润深度和组织学。
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来源期刊
European Journal of Cancer
European Journal of Cancer 医学-肿瘤学
CiteScore
11.50
自引率
4.80%
发文量
953
审稿时长
23 days
期刊介绍: The European Journal of Cancer (EJC) serves as a comprehensive platform integrating preclinical, digital, translational, and clinical research across the spectrum of cancer. From epidemiology, carcinogenesis, and biology to groundbreaking innovations in cancer treatment and patient care, the journal covers a wide array of topics. We publish original research, reviews, previews, editorial comments, and correspondence, fostering dialogue and advancement in the fight against cancer. Join us in our mission to drive progress and improve outcomes in cancer research and patient care.
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