Introduction/Background Evaluation of the prognostic and therapeutic implications of radiologic-clinical discrepancy in parametrial invasion of cervical cancer prior to radical hysterectomy, by comparing patients with radiological suspicion of parametrial invasion and those without .

Methodology Patients diagnosed between 2009–2017, who underwent radical hysterectomy for FIGO (2009) stage IA-IIA cervical cancer were retrospectively selected from the Netherlands Cancer Registry. Logistic regression, Kaplan-Meier estimates, and Cox proportional hazards models were utilized to investigate survival outcomes, risks of adjuvant therapy, and therapy-related toxicity.

Results 886 patients were assessed. Patients in the discrepancy group (n=87, 10%) exhibited larger tumor size (OR 1.04), increased depth of invasion (OR 2.34), more positive LVSI (OR 3.86), more positive pathological lymph nodes (OR 270.6), poorer differentiation grade, increased positive resection margins (OR 83.6) and increased recurrence rate (25% vs 14%). Discrepancy is associated with a decreased lower 5-year DFS of 73.8% (95% CI 62.2 - 82.4%) compared to 86.3% (95% CI 83.4 - 88.6%) and decreased overall 5-year OS rates of 81.5% (95% CI 71.6 - 88.3%) for the discrepancy group compared to 92.2% (95% CI 90.1–93.9%) in the consensus group. After adjustment for confounders the DFS and OS were not independently influenced by discrepancy. Patients in the discrepancy group were more likely to receive adjuvant therapy and experience higher therapy-related toxicity.

Conclusion Cervical cancer patients with a radiologic-clinical discrepancy, are likely to experience lower DFS and OS. This outcome is attributed to poor prognostic factors and a higher incidence of positive resection margins, leading to a greater likelihood of requiring multimodal treatments with impact patient quality of life. Therefore, in cases of diagnostic discrepancy, primary chemoradiation therapy should be considered as a viable alternative. Reevaluation of positive predictive value of the MRI is crucial to determine the reliability of solely using radiological FIGO staging by MRI in clinical practice.

Disclosures None.