Prognostic and therapeutic implications of clinical-radiologic discrepancy in parametrial invasion prior to primary radical hysterectomy in cervical cancer

Sep 29, 2026

Uploaded by Eliana

Study of cervical cancer evaluates how mismatch between clinical assessment and MRI findings for parametrial invasion (PMI) before primary radical hysterectomy influences prognosis and treatment decisions. Patients with radiologic PMI but clinical absence are compared with a consensus group lacking both clinical and radiologic suspicion, using Netherlands Cancer Registry data, Kaplan-Meier/Cox and logistic regression to assess survival, adjuvant therapy use, and therapy-related toxicity. Discrepancy shows poorer prognostic factors and higher adjuvant therapy and toxicity, while adjusted survival outcomes are not independently affected. Results support improved counseling for either chemoradiotherapy or surgery.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Aim and background

Study design and methods

Patient selection and data source

Statistical analyses

Results

Prognostic factors and survival outcomes

Adjuvant therapy and toxicity

Conclusion

Introduction

Gynecologic Oncology Reports 63 (2026) 102002 Contents lists available at ScienceDirect Gynecologic Oncology Reports journal [homepage:](homepage: www.elsevier.com/locate/gynor)[ www.elsevier.com/locate/gynor](homepage: www.elsevier.com/locate/gynor) | Prognostic and therapeutic implications of clinical-radiologic discrepancy in parametrial invasion prior to primary radical hysterectomy in cervical cancer
Ester P. Olthofa,b, Nicholai A. Oostveena,c, Maaike A. van der Aaa, Ruud L.M. Bekkers c,d,e, Constantijne H. Mom b, Jacobus van der Velden b, Joost Nederend f, Edith M.G. van Eschc,g,*
a Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
b Department of Gynecologic Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centre, Centre for Gynecologic Oncology Amsterdam (CGOA), Amsterdam, the Netherlands
c Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands d Department of Obstetrics and Gynecology, Radboudumc, Nijmegen, the Netherlands e GROW School of Medicine, Maastricht, the Netherlands
f Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
g Department of Gynecologic Oncology, Erasmus Medical Center, Erasmus MC Cancer Centre, Rotterdam, the Netherlands | | | | --- | --- | --- | | A R T I C L E I N F O | | A B S T R A C T | | Keywords:
Cervical cancer Neoplasm Staging FIGO classification TNM staging
Magnetic Resonance Imaging | | Aim: This study evaluates the prognostic and therapeutic implications of clinical-radiologic discrepancy in parametrial invasion of cervical cancer prior to radical hysterectomy. We compared patients with radiological presence but clinical absence of parametrial invasion (discrepancy group) to those without radiologic and clinical suspicion of parametrial invasion (consensus group).
Methods: Women with International Federation of Gynaecology and Obstetrics (2009) stage IA-IIA cervical cancer, diagnosed between 2009 and 2017, who underwent magnetic resonance imaging prior to radical hysterectomy were retrospectively selected from the Netherlands Cancer Registry. Kaplan-Meier estimates and Cox proportional hazards were used for survival and logistic regression for risk of adjuvant therapy and toxicity. Results: Of 886 patients included, 87 (10%) had clinical-radiologic parametrial invasion discrepancy. Patients with discrepancy were more likely to have poor prognostic factors (i.e., a larger tumor, increased depth of invasion, lymphovascular space invasion, nodal metastases and positive resection margins) than those without. The 5-year disease-free and overall survival rates were lower in the discrepancy (74% and 82%) than in the consensus group (86% and 92%). However, after confounder adjustments, disease-free and overall survival were not affected by clinical-radiologic discrepancy. Patients with discrepancy in parametrial invasion were more likely to receive adjuvant therapy (54% vs 23%) and experience therapy-related toxicity (44% vs 29%).
Conclusion: Clinical-radiologic discrepancy of parametrial invasion occurs in approximately 10% of patients and is associated with poor prognostic factors and increased likelihood of adjuvant therapy and toxicity. This highlights the importance of addressing these factors in treatment counselling for either primary chemoradiotherapy or surgery. | 1. Introduction Cervical cancer is the fourth most common cancer in women worldwide, with an estimated 604,000 new cases reported in 2020 (Sung et al., 2021). Cervical cancer can spread by local extension to the parametria, known as parametrial invasion (PMI), corresponding to International Federation of Gynecology and Obstetrics (FIGO) stage IIB (Bhatla et al., 2018) PMI is an important parameter for staging patients and determining appropriate treatment. Presence of PMI may direct primary treatment from (radical) surgery to pelvic radiotherapy with

FAQs

What clinical-radiologic discrepancy does the study assess in parametrial invasion?

It compares patients with radiologic presence but clinical absence of parametrial invasion (discrepancy group) against patients without radiologic and clinical suspicion (consensus group) before radical hysterectomy.

How were survival and treatment outcomes analyzed?

Kaplan-Meier estimates and Cox proportional hazards were used for survival, while logistic regression assessed risk of adjuvant therapy and therapy-related toxicity.

Does clinical-radiologic discrepancy affect disease-free and overall survival after adjustments?

After confounder adjustments, disease-free and overall survival were not affected by the discrepancy.

What clinical implications follow from the discrepancy findings?

Discrepancy is associated with poorer prognostic factors and a higher likelihood of adjuvant therapy and toxicity, highlighting the need to address these factors in treatment counseling for chemoradiotherapy or surgery.

Sep 29, 2026

Uploaded by Eliana