Prediction of parametrial invasion of early cervical squamous cell carcinoma: combining apparent diffusion coefficient and greatest primary lesion dimension with hematological variables

Background: Cervical cancer is the fourth most common malignant tumor in women, with cervical squamous cell carcinoma (CSCA) being the most prevalent subtype. Parametrial invasion (PMI) significantly impacts treatment decisions for CSCA patients. Current methods for predicting PMI rely on postoperative histopathological evaluation, which may delay optimal therapy. Combining imaging and hematological markers could improve preoperative risk stratification. Methods: This retrospective study included 134 patients with early stage CSCA who underwent 3.0 T magnetic resonance imaging (MRI) and preoperative hematological examination. We assessed the apparent diffusion coefficient (ADC) value, greatest tumor dimension, squamous cell carcinoma antigen (SCC-Ag) level, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR). Patients were categorized into PMI-positive (n = 22) and PMI-negative (n = 112) groups based on postoperative findings. Receiver operating characteristic (ROC) curves evaluated individual and combined parameters for predicting PMI. Results: Among the 134 patients, PMI was detected in 22 cases, which represented 16.42% of the total population. The ADC value in the PMI-positive group was lower than that in the PMI-negative group, while the greatest dimension and the median SCC-Ag values were higher in the PMI-positive group than in the PMI-negative group. However, there was no significant difference in NLR or PLR between the two groups. The areas under the curve for ADC, greatest dimension, SCC-Ag level, and all three parameters combined were 0.787, 0.765, 0.673 and 0.880, respectively, for predicting PMI. Conclusions: Combining ADC, greatest dimension, and SCC-Ag provides superior accuracy for predicting PMI in early CSCA. This multimodal approach may enable preoperative risk assessment, potentially guiding individualized treatment strategies and reducing unnecessary costs.

Cervical squamous cell carcinoma; Greatest dimension; Diffusion-weighted imaging; Apparent diffusion coefficient; Parametrial invasion; Squamous cell carcinoma antigen

[1] Yang M, Du J, Lu H, Xiang F, Mei H, Xiao H. Global trends and age-specific incidence and mortality of cervical cancer from 1990 to 2019: an international comparative study based on the Global Burden of Disease. BMJ Open. 2022; 12: e055470.

[2] Qin L. Study on the preoperative value of serum SCC-Ag in predicting the stromal invasion of cervical squamous cell carcinoma. Journal of Cancer Research and Clinical Oncology. 2023; 149: 9167–9171.

[3] Jing H, Xiuhong W, Ying Y, Xiyun C, Deping L, Changmei S, et al. Complications of radical hysterectomy with pelvic lymph node dissection for cervical cancer: a 10-year single-centre clinical observational study. BMC Cancer. 2022; 22: 1286.

[4] Kato T, Shimada C, Kato F, Okada‐Kanno H, Takeda M, Endo D, et al. Patterns and predictors of site-specific recurrence in cervical cancer after radical hysterectomy. Journal of Obstetrics and Gynaecology Research. 2022; 48: 3209–3218.

[5] Hoorshad N, Zamani N, Hasani SS, Poopak A, Sharifi A. What are the determinants of parametrial invasion in patients with early stage cervical cancer: a cross sectional study. Annals of Medicine & Surgery. 2022; 79: 104020.

[6] Birge O, Bakir MS, Dogan S, Tuncer HA, Simsek T. The relationship between parametrial involvement and parametrial tissue removed in radical surgery in early-stage cervical cancer. World Journal of Oncology. 2022; 13: 59–68.

[7] Yuan L, Guo J, Zhang X, Chen M, Xu C, Yao L. Feasibility of radical hysterectomy in women with FIGO stage IIB cervical cancer: an observation study of 10-year experience in a tertiary center. Oncotargets and Therapy. 2018; 11: 5527–5533.

[8] Qu J, Qin L, Li X, Luo J, Li J, Zhang H, et al. Predicting parametrial invasion in cervical carcinoma (stages IB1, IB2, and IIA): diagnostic accuracy of T2-weighted imaging combined with DWI at 3 T. American Journal of Roentgenology. 2018; 210: 677–684.

[9] Chen J, Ma N, Sun M, Chen L, Yao Q, Chen X, et al. Prognostic value of apparent diffusion coefficient in neuroendocrine carcinomas of the uterine cervix. PeerJ. 2023; 11: e15084.

[10] Bhardwaj R, Boruah DK, Gogoi BB, Zahir F, Sharma A. Added-value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE-MRI) magnetic resonance imaging in the preoperative assessment of cervical cancer. The Journal of Obstetrics and Gynecology of India. 2022; 72: 330–340.

[11] Kuang F, Ren J, Zhong Q, Liyuan F, Huan Y, Chen Z. The value of apparent diffusion coefficient in the assessment of cervical cancer. European Radiology. 2013; 23: 1050-1058.

[12] Park JJ, Kim CK, Park SY, Park BK, Kim B. Value of diffusion-weighted imaging in predicting parametrial invasion in stage IA2–IIA cervical cancer. European Radiology. 2014; 24: 1081–1088.

[13] Woo S, Kim SY, Cho JY, Kim SH. Apparent diffusion coefficient for prediction of parametrial invasion in cervical cancer: a critical evaluation based on stratification to a Likert scale using T2-weighted imaging. La Radiologia Medica. 2018; 123: 209–216.

[14] Bizzarri N, Biscione A, Moro F, Pedone AL, Catinella V, Certelli C, et al. Prognostic significance of ultrasound characteristics and body mass index in patients with apparent early-stage cervical cancer: a single-center, retrospective, cohort study. Diagnostics. 2023; 13: 583.

[15] Kato T, Takashima A, Kasamatsu T, Nakamura K, Mizusawa J, Nakanishi T, et al. Clinical tumor diameter and prognosis of patients with FIGO stage IB1 cervical cancer (JCOG0806-A). Gynecologic Oncology. 2015; 137: 34–39.

[16] He F, Du J, Chen X, He L. Assessment of parametrial involvement in early stages cervical cancer with preoperative magnetic resonance imaging. International Journal of Gynecologic Cancer. 2018; 28: 1758–1765.

[17] Canaz E, Ozyurek ES, Erdem B, Aldikactioglu Talmac M, Yildiz Ozaydin I, Akbayir O, et al. Preoperatively assessable clinical and pathological risk factors for parametrial involvement in surgically treated FIGO stage IB–IIA cervical cancer. International Journal of Gynecological Cancer. 2017; 27: 1722–1728.

[18] Lura N, Wagner-Larsen KS, Forsse D, Trovik J, Halle MK, Bertelsen BI, et al. What MRI-based tumor size measurement is best for predicting long-term survival in uterine cervical cancer? Insights Into Imaging. 2022; 13: 105.

[19] Zhu H. Squamous cell carcinoma antigen: clinical application and research status. Diagnostics. 2022; 12: 1065.

[20] Charakorn C, Thadanipon K, Chaijindaratana S, Rattanasiri S, Numthavaj P, Thakkinstian A. The association between serum squamous cell carcinoma antigen and recurrence and survival of patients with cervical squamous cell carcinoma: a systematic review and meta-analysis. Gynecologic Oncology. 2018; 150: 190–200.

[21] Zhang G, Miao L, Wu H, Zhang Y, Fu C. Pretreatment squamous cell carcinoma antigen (SCC-Ag) as a predictive factor for the use of consolidation chemotherapy in cervical cancer patients after postoperative extended-field concurrent chemoradiotherapy. Technology in Cancer Research & Treatment. 2021; 20: 15330338211044626.

[22] Huang X, Huo L, Luo Y, Chen K, Li J, Shi L, et al. Clinical utility of pretreatment serum squamous cell carcinoma antigen for prognostication and decision-making in patients with early-stage cervical cancer. Therapeutic Advances in Medical Oncology. 2023; 15: 17588359231165974.

[23] Guo Q, Zhu J, Wu Y, Wen H, Xia L, Wu X, et al. Predictive value of preoperative serum squamous cell carcinoma antigen (SCC-Ag) level on tumor recurrence in cervical squamous cell carcinoma patients treated with radical surgery: a single-institution study. European Journal of Surgical Oncology. 2020; 46: 131–138.

[24] Zhu M, Feng M, He F, Han B, Ma K, Zeng X, et al. Pretreatment neutrophil-lymphocyte and platelet-lymphocyte ratio predict clinical outcome and prognosis for cervical Cancer. Clinica Chimica Acta. 2018; 483: 296–302.

[25] Liu J, Gao D, Li J, Hu G, Liu J, Liu D. The predictive value of systemic inflammatory factors in advanced, metastatic esophageal squamous cell carcinoma patients treated with camrelizumab. Oncotargets and Therapy. 2022; 15: 1161–1170.

[26] Hsu HC, Tai YJ, Chen YL, Chiang YC, Chen CA, Cheng WF. Factors predicting parametrial invasion in patients with early-stage cervical carcinomas. PLOS ONE. 2018; 13: e204950.

[27] Boyraz G, Basaran D, Salman MC, Ozgul N, Yuce K. Clinical and pathological characteristics related to parametrial involvement in clinical early-stage cervical cancer. Ginekologia Polska. 2016; 87: 417–421.

[28] Kilic C, Cakir C, Yuksel D, Tokgozoglu N, Comert GK, Karalok A, et al. Which factors predict parametrial involvement in early stage cervical cancer? A Turkish multicenter study. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2019; 243: 63–66.

[29] Zhang J, Cao D, Yang J, Shen K, He Y, Xue H. Tumor volume predicts high-risk patients and guides initial chemoradiotherapy for early cervical cancer. Frontiers in Oncology. 2021; 11: 640846.

[30] Prabawa IPY, Bharghah A, Liwang F, Tandio DA, Tandio AL, Lestari AAW, et al. Pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as a predictive value of hematological markers in cervical cancer. Asian Pacific Journal of Cancer Prevention. 2019; 20: 863–868.

[31] Manganaro L, Lakhman Y, Bharwani N, Gui B, Gigli S, Vinci V, et al. Staging, recurrence and follow-up of uterine cervical cancer using MRI: updated guidelines of the European society of urogenital radiology after revised FIGO staging 2018. European Radiology. 2021; 31: 7802–7816.

[32] Winarto H, Habiburrahman M, Anggraeni TD, Nuryanto KH, Julianti RA, Purwoto G, et al. The utility of pre-treatment inflammation markers as associative factors to the adverse outcomes of vulvar cancer: a study on staging, nodal involvement, and metastasis models. Journal of Clinical Medicine. 2022; 12: 96.

[33] Xi C, Shen JJ, Burston B, Upadhyay S, Zhou S. Epidemiological/disease and economic burdens of cervical cancer in 2010–2014: are younger women at risk? Healthcare. 2023; 11: 144.

[34] Chayo I, Uribe Perez CJ, De Vries E, Pinheiro PS. The impact of health insurance affiliation and socioeconomic status on cervical cancer survival in Bucaramanga, Colombia. Cancer Epidemiology. 2023; 85: 102375.