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European Radiology

20-11-2023 | Magnetic Resonance Imaging | Urogenital

The value of MRI in quantification of parametrial invasion and association with prognosis in locally advanced cervical cancer: the “PLACE” study

Authors: Luca Russo, Tina Pasciuto, Michela Lupinelli, Alessandra Urbano, Luca D’Erme, Andrea Amerighi, Francesco Fanfani, Giovanni Scambia, Riccardo Manfredi, Evis Sala, Gabriella Ferrandina, Benedetta Gui

Published in: European Radiology

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Abstract

Objective

This retrospective observational study aims to evaluate the association between the extent of parametrial invasion (PMI) and disease-free survival (DFS) and cancer-specific survival (CSS) in patients with locally advanced cervical cancer (LACC).

Materials and methods

This study included patients with LACC showing parametrial invasion at Magnetic Resonance Imaging (MRI). They were treated with neoadjuvant chemo-radiotherapy (CT/RT) before undergoing radical hysterectomy. The staging MRIs were reviewed retrospectively. Measurements of maximum PMI (PMImax) and parametrial length were taken bilaterally. After that, PMIratio was calculated by dividing PMImax by parametrial length.
Analysis was conducted on homogeneous subsets of patients, grouped based on their pathological lymph nodal evaluation (N- and N+). Correlations between PMImax and PMIratio with DFS and CSS were evaluated in both the N- and N+ groups, employing univariable Cox regression analysis.

Results

Out of 221 patients, 126 (57%) had non-metastatic lymph nodes (N-), while 95 (43%) had metastatic lymph nodes (N+). The median observation period for all these patients was 73 months (95% confidence interval [CI]: 66–77). The 5-year DFS and CSS probability rates were 75% and 85.7%, respectively, for the N- group and 54.3% and 73.6%, respectively, for the N+ group. A higher PMImax (hazard ratio [HR] = 1.09) and PMIratio (HR = 1.04) correlated with worse overall survival in patients in the N- group (p = 0.025 and p = 0.042). These parameters did not show a significant statistical association in the N+ group.

Conclusions

The degree of PMI evaluated on MRI affects outcome in N- patients with LACC.

Clinical relevance statement

The degree of MRI parametrial invasion affects disease-free survival and cancer-specific survival in patients with the International Federation of Gynecology and Obstetrics (FIGO) stage IIB cervical cancer. This MRI finding can be easily incorporated into routine clinical practice.

Key Points

• Visual assessment of parametrial invasion on MRI was not significantly associated with prognosis in locally advanced cervical cancer (LACC).
• A greater degree of parametrial invasion is associated with poorer disease-free survival and cancer-specific survival in patients with LACC without metastatic lymph node involvement.
• The degree of parametrial invasion at MRI has no correlation with prognosis in LACC with metastatic lymph nodes.
Appendix
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Metadata
Title
The value of MRI in quantification of parametrial invasion and association with prognosis in locally advanced cervical cancer: the “PLACE” study
Authors
Luca Russo
Tina Pasciuto
Michela Lupinelli
Alessandra Urbano
Luca D’Erme
Andrea Amerighi
Francesco Fanfani
Giovanni Scambia
Riccardo Manfredi
Evis Sala
Gabriella Ferrandina
Benedetta Gui
Publication date
20-11-2023
Publisher
Springer Berlin Heidelberg
Published in
European Radiology
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-023-10443-3