Criteria for predicting ovarian metastasis in early-stage cervical adenocarcinoma

Objectives: To evaluate the clinicopathologic risk factors for and construct criteria to predict the risk of ovarian metastasis in early-stage cervical adenocarcinoma. Materials and Methods: Subjects were cervical adenocarcinoma patients with International Federation of Gynecology and Obstetrics (FIGO) Stage less than or equal to IIB who underwent hysterectomy and bilateral salpingo-oophorectomy and pelvic lymphadenectomy at this institution between January 2010 and December 2017. Clinicopathologic variables were studied by univariate and logistic regression analysis to identify the risk factors, and then criteria were built. Results: Four hundred and nineteen patients were enrolled in the study, and ovarian metastasis rate was 4.50% (19/419). Eight patients had normal appearance, and 14 patients had bilateral ovarian metastases. Univariate analysis revealed that clinical stage (p < 0.001), preoperative hemoglobin (p = 0.017), preoperative red blood cell count (p = 0.001), histology type (p < 0.001), deep cervical stromal invasion (p < 0.001), lymphatic vascular space invasion (p < 0.001), parametrial invasion (p < 0.001), marginal invasion (p < 0.001), vaginal invasion (p < 0.001), uterine corpus invasion (p < 0.001) , fallopian tube invasion (p < 0.001), and pelvic lymph node metastasis (p < 0.001) were associated with ovarian metastasis. The logistic regression analysis revealed that clinical stage (odds ratio, OR, 11.747; 95% confidence interval, CI, 1.969-70.082), histology type (OR, 5.069; 95% CI, 1.249-24.904), lymphatic vascular space invasion (OR, 13.369; 95% CI, 2.194-81.469,) and fallopian tube invasion (OR, 124.305; 95% CI, 20.969-736.871) were independently associated with ovarian metastasis. When the clinical stage, histology type, lymphatic vascular space invasion, and fallopian tube invasion were considered as high-risk factors for ovarian metastasis, the sensitivity, specificity, positive predictive value, and negative predictive value were found to be 100.00%, 58.76%, 10.00%, 100.00%, and 60.57%, respectively. Conclusion: Clinical stage, histology type, lymphatic vascular space invasion, and fallopian tube metastasis may be used in the prediction of ovarian metastasis in early-stage cervical adenocarcinoma.

Adenocarcinoma; Ovarian metastasis; Ovarian preservation; Clinical risk factors.

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