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

## TL;DR

A mismatch between clinical and radiologic findings of parametrial invasion in cervical cancer is linked to worse outcomes and more treatment toxicity, affecting about 10% of patients.

## Contribution

This study identifies clinical-radiologic discrepancy in parametrial invasion as a significant factor affecting treatment decisions and outcomes in cervical cancer patients.

## Key findings

- Discrepancy in parametrial invasion is associated with poor prognostic factors like larger tumors and lymph node metastases.
- Patients with discrepancy had higher rates of adjuvant therapy (54% vs 23%) and therapy-related toxicity (44% vs 29%).
- Despite lower initial survival rates, adjusted analysis showed no survival impact from clinical-radiologic discrepancy.

## Abstract

•Clinical-radiologic discrepancy of parametrial invasion in cervical cancer is a therapeutic dilemma.•Discrepancy in parametrial invasion at diagnosis is associated with poor prognostic factors of cervical cancer.•Discrepancy of parametrial invasion is associated with positive resection margins and increased multimodality treatment.•Patients with discrepancy of parametrial invasion at diagnosis experience more therapy-related toxicity (44% vs 29%)•Future research on optimalisation of MRI diagnostics and value of clinical examination (under anesthesia) is important.

Clinical-radiologic discrepancy of parametrial invasion in cervical cancer is a therapeutic dilemma.

Discrepancy in parametrial invasion at diagnosis is associated with poor prognostic factors of cervical cancer.

Discrepancy of parametrial invasion is associated with positive resection margins and increased multimodality treatment.

Patients with discrepancy of parametrial invasion at diagnosis experience more therapy-related toxicity (44% vs 29%)

Future research on optimalisation of MRI diagnostics and value of clinical examination (under anesthesia) is important.

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).

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.

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%).

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.