How often parametrial involvement leads to post-operative adjuvant treatment in locally advanced XXXX after neoadjuvant chemotherapy and type C radical hysterectomy?

@entity5 @entity1
OBJECTIVE: Parametrial involvement (PMI) is one of the most important factors influencing prognosis in locally advanced @entity5 (LACC) @entity1 . We aimed to evaluate PMI rate among LACC @entity1 undergoing neoadjuvant chemotherapy (NACT), thus evaluating the utility of parametrectomy in tailor adjuvant treatments. METHODS: Retrospective evaluation of consecutive 275 @entity1 affected by LACC (IB2-IIB), undergoing NACT followed by type C/class III radical hysterectomy. Basic descriptive statistics, univariate and multivariate analyses were applied in order to identify factors predicting PMI. Survival outcomes were assessed using Kaplan-Meier and Cox models. RESULTS: PMI was detected in 37 (13%) @entity1 : it was associated with vaginal involvement, lymph node positivity and both in 10 (4%), 5 (2%) and 12 (4%) @entity1 , respectively; while PMI alone was observed in only 10 (4%) @entity1 . Among this latter group, adjuvant treatment was delivered in 3 (1%) @entity1 on the basis of pure PMI; while the remaining @entity1 had other characteristics driving adjuvant treatment. Considering factors predicting PMI we observed that only suboptimal pathological responses (OR: 1.11; 95% CI: 1.01, 1.22) and vaginal involvement (OR: 1.29 (95%) CI: 1.17, 1.44) were independently associated with PMI. PMI did not correlate with survival (HR: 2.0; 95% CI: 0.82, 4.89); while clinical response to NACT (HR: 3.35; 95% CI: 1.59, 7.04), vaginal involvement (HR: 2.38; 95% CI: 1.12, 5.02) and lymph nodes positivity (HR: 3.47; 95% CI: 1.62, 7.41), independently correlated with worse survival outcomes. CONCLUSIONS: Our data suggest that PMI had a limited role on the choice to administer adjuvant treatment, thus supporting the potential embrace of less radical surgery in LACC @entity1 undergoing NACT. Further prospective studies are warranted.
