Development of criteria for ovarian preservation in cervical cancer patients treated with radical surgery with or without neoadjuvant chemotherapy: a multicenter retrospective study and meta-analysis.

Abstract

BACKGROUND:

There is no consensus on the selection criteria for ovarian preservation in cervical cancer, and the role of neoadjuvant chemotherapy (NACT) on ovarian metastasis (OM) is also unknown.

METHODS:

A total of 1,889 cervical cancer patients with International Federation of Gynecology and Obstetrics (FIGO) stages IB to IIB who underwent radical hysterectomy, pelvic lymphadenectomy, and bilateral salpingo-oophorectomy with or without NACT were enrolled. Clinicopathologic variables were studied by univariate and multivariate analyses. Meta-analyses of published data for risk factors of OM were also performed.

RESULTS:

Twenty-two (1.2%) of 1,889 patients were diagnosed as OM: 12 squamous cell carcinomas (SCC, 0.7%), five adenocarcinomas (2.7%), four adenosquamous carcinomas (5.6%), and one small cell carcinoma (7.7%). Multivariate analysis revealed that lymph node metastasis (LNM; odds ratio 5.75, 95% confidence interval 2.16-15.28), corpus uteri invasion (CUI; 5.53, 2.11-14.53), parametrial invasion (PMI; 8.24, 3.01-22.56), and histology and NACT (0.40, 0.13-1.22) were associated with OM. Furthermore, OM in patients with SCC was associated with PMI (5.67, 1.63-19.72), CUI (3.25, 0.88-12.01), and LNM (9.44, 2.43-36.65). FIGO stage (IIB vs. IB; 31.78, 1.41-716.33), bulky tumor size (12.71, 1.31-123.68), PMI (51.21, 4.10-639.19), NACT (0.003, 0.00-0.27), and CUI (44.49, 2.77-714.70) were independent clinicopathologic factors for OM in adenocarcinomas. In the meta-analysis, we identified six risk factors for OM: LNM, CUI, PMI, adenocarcinoma, large tumor size, and lymphovascular space involvement.

CONCLUSIONS:

Ovarian preservation surgery may be safe in SCC patients without suspicious LNM, PMI, and CUI, and in adenocarcinomas in patients who received NACT without FIGO stage IIB disease, bulky tumor size (>4 cm), suspicious PMI, and CUI.

• Authors: Ting Hu, Li Wu, Hui Xing, Ru Yang, Xiong Li, Kecheng Huang, Yao Jia, Qinghua Zhang, Zhilan Chen, Shaoshuai Wang, Dan Liu, Xiaobing Han, Zhongqiu Lin, Pengpeng Qu, Hongbing Cai, Xiaojie Song, Xiaoyu Tian, Hui Wang, Shixuan Wang, Xing Xie, Shuang Li, Ding Ma
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 20 Issue 3 Pg. 881-90 (Mar 2013) ISSN: 1534-4681 [Electronic] United States
• PMID: 23054110 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Adenocarcinoma (pathology, therapy)
• Adult
• Carcinoma, Adenosquamous (pathology, therapy)
• Carcinoma, Small Cell (pathology, therapy)
• Carcinoma, Squamous Cell (pathology, therapy)
• Case-Control Studies
• Combined Modality Therapy
• Female
• Fertility Preservation
• Follow-Up Studies
• Humans
• Hysterectomy
• Lymphatic Metastasis
• Meta-Analysis as Topic
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Staging
• Ovarian Neoplasms (secondary, therapy)
• Prognosis
• Retrospective Studies
• Survival Rate
• Uterine Cervical Neoplasms (pathology, therapy)