Abstract
Background
The aim of the present study was to assess the prognostic value of tumour-free distance (TFD), defined as the minimum distance of uninvolved stroma between the tumour and peri-cervical stromal ring, in early-stage cervical cancer.
Methods
Patients with pathologic FIGO 2009 stage IA1–IIA2 cervical cancer, treated by primary radical surgical treatment between 01/2000 and 11/2019, were retrospectively included. Adjuvant treatment was administered according to the presence of previously established pathologic risk factors. TFD was measured histologically on the hysterectomy specimen. Pre-operative TFD measured at MRI-scan from a cohort of patients was reviewed and compared with pathology TFD.
Results
395 patients were included in the study. 93 (23.5%) patients had TFD ≤ 3.0 mm and 302 (76.5%) had TFD > 3.0 mm. TFD ≤ 3.0 mm together with lymph vascular space involvement represented the strongest predictor for lymph node metastasis at multivariate analysis. TFD ≤ 3.0 mm was associated with worse 5-year disease-free survival (DFS) and overall survival (OS), compared with TFD > 3.0 mm (p = 0.022 and p = 0.008, respectively). DFS difference was more evident in the subgroup of patients with low-risk factors who did not receive adjuvant treatment (p = 0.002). Cohen’s kappa demonstrated an agreement between TFD measured at pre-operative MRI-scan and histology of 0.654.
Conclusions
Pathologic TFD ≤ 3.0 mm represents a poor prognostic factor significantly associated with lymph node metastasis and it may be considered a novel marker to select candidates for adjuvant treatment. The possibility to obtain this parameter by radiological imaging makes it a potential easy-measurable pre-operative marker to predict the presence of high-risk pathologic factors in early-stage cervical cancer.
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Acknowledgements
The authors would like to thank the surgical team and the scrub nurses at Policlinico Gemelli IRCCS, Rome, Italy.
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Conceptualisation, N.B. and G.S.; Methodology, N.B., L.P.A., G.F.Z., B.G., G.A., V.G., A.F. and F.F.; Software, N.B. and L.P.A.; Validation, V.G., V.C., G.F., F.F. and A.F.; Formal analysis, N.B., L.P.A.; Investigation, V.C., M.B. and C.F.; Data curation, N.B., V.C., M.B. and C.F.; Writing—original draft preparation, N.B., F.F., G.F. and G.S.; Writing—review & editing V.G., V.C., G.F., F.F., A.F. and G.S.; Supervision, G.F.; Project administration, N.B.
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The present study was approved by Institutional Review Board (Number DIPUSVSP-03-02-208, date: 03/02/2020) and performed in accordance with the Declaration of Helsinki.
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Bizzarri, N., Pedone Anchora, L., Zannoni, G.F. et al. Validation of tumour-free distance as novel prognostic marker in early-stage cervical cancer: a retrospective, single-centre, cohort study. Br J Cancer 125, 561–568 (2021). https://doi.org/10.1038/s41416-021-01384-z
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DOI: https://doi.org/10.1038/s41416-021-01384-z
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