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Article

Nomogram Predicting the Likelihood of Parametrial Involvement in Early-Stage Cervical Cancer: Avoiding Unjustified Radical Hysterectomies

by
Louise Benoit
1,*,
Vincent Balaya
1,2,
Benedetta Guani
2,3,
Arnaud Bresset
4,
Laurent Magaud
5,
Helene Bonsang-Kitzis
6,
Charlotte Ngô
6,
Patrice Mathevet
2,3 and
Fabrice Lécuru
1,7
1
Faculty of Medicine, Paris University, 75006 Paris, France
2
Gynecology Department, Centre Hospitalo-Universitaire Vaudois, 1011 Lausanne, Switzerland
3
University of Lausanne, Department of Gynecology and Obstetrics, 1011 Lausanne, Switzerland
4
Gynecology and Obstetrics Department, Beaujon Hospital, 92110 Clichy, France
5
Public Health Department, Hospices Civils de Lyon, 69002 Lyon, France
6
Gynecological and Breast Surgery and Cancerology Center, RAMSAY-Générale de Santé, Hôpital Privé des Peupliers, 75013 Paris, France
7
Breast, Gynecology and Reconstructive Surgery Unit, Curie Institute, 75005 Paris, France
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(7), 2121; https://doi.org/10.3390/jcm9072121
Submission received: 14 June 2020 / Revised: 28 June 2020 / Accepted: 1 July 2020 / Published: 5 July 2020
(This article belongs to the Special Issue Screening and Tests for Gynecologic Cancer)
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Abstract

Background: We aimed to establish a tool predicting parametrial involvement (PI) in patients with early-stage cervical cancer and select a sub-group of patients who would most benefit from a less radical surgery. Methods: We retrospectively reviewed patients from two prospective multicentric databases—SENTICOL I and II—from 2005 to 2012. Patients with early-stage cervical cancer (FIGO 2018 IA with lympho-vascular involvement to IIA1), undergoing radical surgery (hysterectomy or trachelectomy) with bilateral sentinel lymph node (SLN) mapping with no metastatic node or PI on pre-operative imaging, were included. Results: In total, 5.2% patients (11/211) presented a histologic PI. After univariate analysis, SLN status, lympho-vascular space invasion, deep stromal invasion and tumor size were significantly associated with PI and were included in our nomogram. Our predictive model had an AUC of 0.92 (IC95% = 0.86–0.98) and presented a good calibration. A low risk group, defined according to the optimal sensitivity and specificity, presented a predicted probability of PI of 2%. Conclusion: Patients could benefit from a two-step approach. Final surgery (i.e. radical surgery and/or lymphadenectomy) would depend on the SLN status and the probability PI calculated after an initial conization with bilateral SLN mapping.
Keywords: cervical cancer; nomogram; parametrium; parametrial involvement; radical hysterectomy; radical trachelectomy cervical cancer; nomogram; parametrium; parametrial involvement; radical hysterectomy; radical trachelectomy

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MDPI and ACS Style

Benoit, L.; Balaya, V.; Guani, B.; Bresset, A.; Magaud, L.; Bonsang-Kitzis, H.; Ngô, C.; Mathevet, P.; Lécuru, F. Nomogram Predicting the Likelihood of Parametrial Involvement in Early-Stage Cervical Cancer: Avoiding Unjustified Radical Hysterectomies. J. Clin. Med. 2020, 9, 2121. https://doi.org/10.3390/jcm9072121

AMA Style

Benoit L, Balaya V, Guani B, Bresset A, Magaud L, Bonsang-Kitzis H, Ngô C, Mathevet P, Lécuru F. Nomogram Predicting the Likelihood of Parametrial Involvement in Early-Stage Cervical Cancer: Avoiding Unjustified Radical Hysterectomies. Journal of Clinical Medicine. 2020; 9(7):2121. https://doi.org/10.3390/jcm9072121

Chicago/Turabian Style

Benoit, Louise, Vincent Balaya, Benedetta Guani, Arnaud Bresset, Laurent Magaud, Helene Bonsang-Kitzis, Charlotte Ngô, Patrice Mathevet, and Fabrice Lécuru. 2020. "Nomogram Predicting the Likelihood of Parametrial Involvement in Early-Stage Cervical Cancer: Avoiding Unjustified Radical Hysterectomies" Journal of Clinical Medicine 9, no. 7: 2121. https://doi.org/10.3390/jcm9072121

APA Style

Benoit, L., Balaya, V., Guani, B., Bresset, A., Magaud, L., Bonsang-Kitzis, H., Ngô, C., Mathevet, P., & Lécuru, F. (2020). Nomogram Predicting the Likelihood of Parametrial Involvement in Early-Stage Cervical Cancer: Avoiding Unjustified Radical Hysterectomies. Journal of Clinical Medicine, 9(7), 2121. https://doi.org/10.3390/jcm9072121

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