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

• Published in: Annals of surgical oncology 2013-03, Vol.20 (3), p.881-890
• Main Authors: Hu, Ting, Wu, Li, Xing, Hui, Yang, Ru, Li, Xiong, Huang, Kecheng, Jia, Yao, Zhang, Qinghua, Chen, Zhilan, Wang, Shaoshuai, Liu, Dan, Han, Xiaobing, Lin, Zhongqiu, Qu, Pengpeng, Cai, Hongbing, Song, Xiaojie, Tian, Xiaoyu, Wang, Hui, Wang, Shixuan, Xie, Xing, Li, Shuang, Ma, Ding
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - therapy; Adult; Carcinoma, Adenosquamous - pathology; Carcinoma, Adenosquamous - therapy; Carcinoma, Small Cell - pathology; Carcinoma, Small Cell - therapy; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Case-Control Studies; Cervical cancer; Combined Modality Therapy; Female; Fertility Preservation; Follow-Up Studies; Gynecologic Oncology; Humans; Hysterectomy; Lymphatic Metastasis; Medicine; Medicine & Public Health; Meta-Analysis as Topic; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Oncology; Ovarian Neoplasms - secondary; Ovarian Neoplasms - therapy; Prognosis; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - therapy
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-012-2632-8

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.