Brynhildur Eyjolfsdottir

The Silva pattern-based classification and oncological outcomes in women undergoing fertility-sparing surgery for early-stage cervical cancer

To explore the association between Silva pattern-based classification, lymphovascular invasion, and oncological outcomes in women undergoing fertility-sparing surgery for cervical cancer. Retrospective nationwide cohort study of patients with human papillomavirus (HPV)-associated cervical adenocarcinomas <2 cm undergoing radical vaginal trachelectomy, simple vaginal trachelectomy, or conization with nodal assessment between 2000 and 2022. Clinical data were retrieved from electronic medical records and institutional databases. Histological specimens were retrospectively assigned the Silva pattern classification after review by an expert gynecologic oncology pathologist. The primary endpoint was recurrence-free survival categorized by the Silva pattern classification. Survival rates were compared between groups defined by the Silva pattern classification using Kaplan-Meier estimates. Of 61 women with cervical adenocarcinoma, 59 were HPV-associated, with HPV 16 and 18 being the most prevalent genotypes. Among HPV-associated adenocarcinomas, 20 (33.9%) were classified as pattern A, 26 (44.1%) as pattern B, and 13 (22.0%) as pattern C. HPV 18 was noted in 9 (69.2%) of tumors with pattern C, compared to 7 (35.5%) and 10 (38.5%) in patterns A and B, respectively. Most cases were International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB1 (N = 50 [84.8%]). Lymphovascular invasion was present in 6 (23.1%) of cases with pattern B and in 7 (53.9%) with pattern C. There was no difference in surgical radicality between groups. Five women abandoned fertility preservation due to nodal metastasis (N = 2), positive surgical margins (N = 2), or multifocal disease (N = 1). Of these, 3 tumors exhibited pattern C, 1 pattern B with lymphovascular invasion, and 1 pattern B without lymphovascular invasion. Median follow-up was 79 months (range; 14-248 months). Five-year recurrence-free survival was 100% for the Silva patterns A and B, compared to 75.5% for pattern C (95% CI 41.6% to 91.4%). Recurrence occurred exclusively among patients with the Silva pattern C, highlighting the prognostic potential of this classification system. Silva classification should be considered when counseling women regarding fertility-sparing surgery.

Sexual Health and Quality of Life in Patients With Low-Risk Early-Stage Cervical Cancer: Results From GCIG/CCTG CX.5/SHAPE Trial Comparing Simple Versus Radical Hysterectomy

PURPOSE Simple hysterectomy and pelvic node assessment (SHAPE) is a phase III randomized trial (ClinicalTrials.gov identifier: NCT01658930 ) reporting noninferiority of simple compared with radical hysterectomy for oncologic outcomes in low-risk cervical cancer. This study presents secondary outcomes of sexual health and quality of life (QOL) of the SHAPE trial. METHODS Participants were randomly assigned to receive either radical or simple hysterectomy. Sexual health was assessed up to 36 months postoperatively using the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised and QOL using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Cervical Cancer-Specific Module (QLQ-CX24) questionnaires. RESULTS Among participants with at least one QOL measure, clinical and pathologic characteristics were balanced and with no differences in preoperative baseline scores for sexual health or QOL between groups. FSFI total score met the cutoff for dysfunction up to 6 months ( P = .02) in the radical hysterectomy group. Group differences favored simple hysterectomy for FSFI subscales: desire and arousal at 3 months ( P ≤ .001) and pain and lubrication up to 12 months ( P ≤ .018). Both groups met the cutoff for sexual distress but was higher in radical hysterectomy at 3 months ( P = .018). For QLQ-CX24, symptom experience was significantly better up to 24 months ( P = .031) and body image better at 3, 24, and 36 months ( P ≤ .01) for simple hysterectomy. Sexual-vaginal functioning was significantly better up to 24 months ( P ≤ .022) and more sexual activity up to 36 months ( P = .024) in the simple hysterectomy arm. Global health status was significantly higher at 36 months for simple hysterectomy ( P = .025). CONCLUSION Simple hysterectomy was associated with lower rates of sexual dysfunction than radical hysterectomy, with a lower proportion of women having sustained sexual-vaginal dysfunction. These results further support the benefit of surgical de-escalation for low-risk cervical cancer.

The detection rate of metastatic lymph nodes comparing sentinel lymph node biopsy and lymphadenectomy for staging of intermediate- and high-risk endometrial carcinoma

The primary aim of this study was to compare the detection rates of nodal metastases between lymphadenectomy (LND) and sentinel lymph node (SLN) in intermediate- and high-risk patients with assumed uterine-confined disease. This was a single-center observational study of patients from a tertiary referral center (2006-2023). Intermediate risk was defined as endometrioid adenocarcinoma grade 1/2 with ≥50% myoinvasion or grade 3 with <50% myoinvasion. High risk was defined as endometrioid adenocarcinoma grade 3 with ≥50% myoinvasion, non-endometrioid histologies regardless of myoinvasion or cervical involvement of any histology, and myoinvasion. All SLNs underwent pathologic ultra-staging. Nodal metastases were defined as the presence of macro- or micro-metastases. The comparison of metastatic lymph node rates by nodal assessment method was performed using the χ A total of 996 patients were included (333 in the intermediate-risk group and 663 in the high-risk group). In the intermediate-risk group 192/333 (58%) patients underwent LND and 141/333 (42%) underwent SLN. Nodal metastases were detected in 11% and 9% of the LND and SLN cohorts (p = .46). Increasing proportions of staged patients were observed after SLN implementation (57% vs 78%) (p < .001). In the high-risk group, 412/663 (62%) patients underwent LND, and 251/663 (38%) underwent SLN. Nodal metastases were detected in 19% and 14% of the LND and SLN cohorts, respectively (p = .11). The majority of isolated tumor cells were observed in endometrioid histologies compared to non-endometrioid histologies (71% vs 29%, p = .01). Increasing proportions of staged patients were observed after SLN implementation (82% vs 88%) (p = .02). In the multivariable analysis, no association was observed between the nodal assessment method and the detection rates of nodal metastases in either risk group. In this predominantly high-risk population, the implementation of an SLN algorithm did not compromise the detection of nodal metastases. As more patients are comprehensively staged after SLN implementation, we expect more accurate surgical staging and adjuvant therapy allocation in this specific patient group in the future.

Radical Versus Simple Hysterectomy and Pelvic Node Dissection With Low-risk Early Stage Cervical Cancer

The reason this study is being done is to see if a simple hysterectomy is as good as a radical hysterectomy in preventing cancer of the cervix from returning, and whether, because less tissue surrounding the uterus is removed during surgery, there are fewer side-effects after the surgery and in the long-term.