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Different patterns of tumor size and serum SCC antigen level for prediction of parametrial invasion in pre- and post-menopausal patients with FIGO stage IB cervical cancer

Kong, Tae Wook; Chang, Suk-Joon; Kang, Seong Woo; Paek, Jiheum; Ryu, Hee-Sug
Department of Obstetrics & Gynecology, Ajou University School of Medicine
OBJECTIVE: The aim of this study was to identify preoperatively high- and low-risk subgroups of patients with parametrial involvement according to menopausal status in patients with FIGO stage IB cervical cancer treated with radical hysterectomy.
METHODS: We retrospectively reviewed data from 191 patients with FIGO stage IB cervical cancer. All patients had no definite evidence of parametrial invasion and lymph node metastasis in preoperative examination and underwent type III radical hysterectomy with retroperitoneal lymphadenectomy between February 2006 and April 2014. Preoperative risk criteria predicting parametrial involvement were determined in preand post-menopausal women, respectively.
RESULTS: In pre-menopausal women, tumor size on magnetic resonance imaging (MRI) ≥4 cm (OR, 118.925; [95% CI, 6.712-2107.183]; p=0.001) and serum SCC Ag level ≥3.60 ng/mL (OR, 22.933; [95% CI, 2.234 235.419]; p=0.008) were independent factors for parametrial invasion. Significant factors associated with parametrial involvement in post-menopausal women were tumor size on MRI ≥3 cm (OR, 3.895; [95% CI, 0.990-15.321]; p=0.052) and serum SCC Ag level ≥1.20 ng/mL (OR, 4.341; [95% CI, 1.123-16.774]; p=0.033). Patients were categorized into lowand high-risk patients according to risk criteria. There were significant differences in the rates of microscopic parametrial invasion between the two groups (0.0% vs 42.2% in pre-menopausal group; p<0.001, 7.4% vs 54.1% in postmenopausal group; p<0.001).
CONCLUSION: A model using preoperative tumor size on MRI and SCC Ag level is highly predictive of microscopic parametrial invasion in patients with FIGO stage IB cervical cancer. However, the criteria for parametrial invasion may be different according to menopausal status.
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