Feasibility of radical hysterectomy in women with FIGO stage IIB cervical cancer: an observation study of 10-year experience in a tertiary center

Abstract

Purpose: Although definitive chemoradiotherapy is considered as a standard of care for FIGO stage IIB cervical cancer in many countries, the role of surgery remains controversial. We aimed to evaluate the feasibility and outcomes of patients with FIGO stage IIB cervical cancer who received radical surgery in China.

Patients and methods: A total of 74 women with FIGO stage IIB cervical cancer were treated with radical hysterectomy, with or without adjuvant radio/chemoradiotherapy, at the Obstetrics and Gynecology Hospital of Fudan University between 2004 and 2015. Medical charts and clinical data were retrospectively reviewed. The Kaplan-Meier method and Cox regression models were used for survival analyses. In addition, prognostic nomograms predicting overall survival (OS) and progression-free survival (PFS) were constructed.

Results: Pathological parametrial involvement (PMI) was only identified in 28.3% (21/74) of all patients and 47.3% (9/19) of patients without neoadjuvant treatment. Major surgical complications, including bladder fistula, intestinal obstruction and ureteral injury, were found in 6.8% (5/74) of patients. Although the use of imaging technologies including magnetic resonance imaging (MRI)/positron emission tomography-computed tomography (PET-CT) has increased after 2010 compared to that prior to 2010, the accuracy of MRI/PET-CT in detecting pathological PMI was lower than that of physical examination under anesthesia (P<0.05). Neoadjuvant treatment was the only risk factor affecting the accuracy of pre- and postoperative accordance of PMI (OR: 3.283 [95% CI: 1.363-7.908], P=0.008). The 2- and 5-year OS rates were 84.1% and 68.9%, respectively, while the 2- and 5-year cumulative recurrence rates were 26.9% and 39.9%, respectively. Cox regression analyses indicated that pre- and postoperative accordance of PMI, common iliac lymph node metastasis and major surgical complications were significant prognostic factors for both OS and PFS.

Conclusion: Radical hysterectomy might be a feasible alternative for FIGO stage IIB cervical cancer. As pre- and postoperative accordance of PMI is relatively low, strategies to appropriately select patients who will benefit from surgery via pretreatment evaluation need to be further investigated.

Keywords: locally advanced cervical cancer; parametrial involvement; radical hysterectomy; surgery.

Figure 1

The usage of MRI and PET–CT in different periods of time. Abbreviations: MRI, magnetic resonance imaging; PET–CT, positron emission tomography–computed tomography.

Figure 2

OS rate and cumulative recurrence rate of FIGO stage IIB patients. Abbreviation: OS, overall survival.

Figure 3

Nomograms for predicting PFS and OS, which had a bootstrap-corrected C-index of 0.763 and 0.745, respectively. Notes: To use, find patient’s status of pre- and postoperative accordance of PMI, then draw straight line upward to points axis to determine how many points patient receives for accordance rate. Do this again for other axes, each time drawing straight line upward toward points axis. Sum points received for each predictor, and find sum on axis of total points. Draw straight line down to survival-probability axis to find patient’s probability of 1, 2, 3, 5-year PFS and OS. Abbreviations: PFS, progression-free survival; OS, overall survival; C-index, concordance index; PMI, parametrial involvement; LN, lymph node.