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Molecular Diagnostics

Validation of tumour-free distance as novel prognostic marker in early-stage cervical cancer: a retrospective, single-centre, cohort study

British Journal of Cancer volume 125, pages 561–568 (2021)Cite this article

Subjects

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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Fig. 1: Distribution of patients according to ‘classic’ risk factors.
Fig. 2: Survival according to TFD.
Fig. 3: Survival outcomes in low-risk patients without adjuvant treatment.

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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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Authors and Affiliations

  1. Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy

    Nicolò Bizzarri, Luigi Pedone Anchora, Vittoria Carbone, Matteo Bruno, Camilla Fedele, Valerio Gallotta, Francesco Fanfani, Anna Fagotti, Giovanni Scambia & Gabriella Ferrandina

  2. Fondazione Policlinico Universitario A. Gemelli, IRCCS, Gyneco-pathology and Breast Pathology Unit, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy

    Gian Franco Zannoni

  3. Università Cattolica del Sacro Cuore, Rome, Italy

    Gian Franco Zannoni, Francesco Fanfani, Anna Fagotti, Giovanni Scambia & Gabriella Ferrandina

  4. ARNAS Ospedali Civico Di Cristina Benfratelli, Department of Gynecologic Oncology, University of Palermo, Palermo, Italy

    Vito Chiantera

  5. Fondazione Policlinico Universitario A. Gemelli, IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy

    Giacomo Avesani & Benedetta Gui

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  1. Nicolò Bizzarri
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Contributions

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.

Corresponding author

Correspondence to Giovanni Scambia.

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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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