Introduction Tumor-free distance (TFD), defined as the minimum distance of uninvolved stroma between the tumor and peri-cervical stromal ring, was recently proposed as predictive marker of recurrence in patients with early-stage cervical cancer treated by primary surgery (particularly if ≤3.5 mm). The aims of the present study were to assess the prognostic value of TFD and to compare TFD with other known prognostic markers in early-stage cervical cancer.
Methods Patients with pathologic FIGO 2009 stage IA1-IIB cervical cancer, treated by primary radical surgical treatment between 01/2000 and 12/2018, 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.
Results 368 patients were included in the study. 115 (31.2%) patients had TFD≤3.5 mm and 253 (68.8%) had TFD>3.5 mm. TFD≤3.5 mm was associated with worse 5-year disease-free survival (DFS) and overall survival (OS), compared with TFD>3.5 mm (p=0.028 and p=0.041, respectively) (figure 1). DFS and OS differences were more evident in subgroups of patients who did not receive adjuvant treatment (DFS, p=0.001 and OS, p=0.001) and who underwent laparotomy approach (DFS, p=0.017 and OS, p=0.034). TFD≤3.5 mm represented the strongest predictor for lymph node metastasis and pathologic parametrial involvement at both univariate and multivariate analysis (table 1).
Conclusions TFD≤3.5 mm represents a poor prognostic factor significantly associated with lymph node metastasis and pathologic parametrial infiltration. The possibility to obtain this parameter by radiological imaging makes it the easiest measurable pre-operative marker to predict the presence of high-risk pathologic factors.
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