宫颈癌的术前分期：从膀胱镜检查转向MRI的时间。

IF 4.7 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Radiology Pub Date : 2025-10-04 DOI:10.1007/s00330-025-12039-5

Matteo Bonatti, Riccardo Valletta, Luca D'Erme, Miriam Dolciami, Roberta Chianura, Pietro Paolo Maria Azzaro, Chiara Innocenzi, Nicolò Bizzarri, Vincenzo Vingiani, Giovanni Negri, Martin Steinkasserer, Sara Notaro, Francesca Vanzo, Elena Magri, Benedetta Gui, Evis Sala, Giacomo Avesani

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引用次数: 0

摘要

目的：评价mri定义的宫颈癌（CC）膀胱壁侵犯对疾病复发和总生存的影响。材料和方法：经irb批准的多中心回顾性研究，包括对组织学证实的CC进行分期MRI检查的女性（2015年1月- 2020年12月）。图像分析由两名放射科医生独立完成。如果满足以下标准≥3项，即宫颈-膀胱脂肪面消失、膀胱壁增厚、膀胱壁t2 -低密度消失、存在腔内肿瘤生长，则诊断为膀胱壁侵犯。将MRI结果与内镜/细胞学检查结果进行比较。采用logistic回归评估mri定义的膀胱壁侵犯对肿瘤复发和生存的影响。生存曲线比较采用log-rank检验。结果：我们纳入214名女性，中位年龄为55岁（IQR 47-65）。21.5%的患者有mri定义的膀胱壁侵犯。膀胱镜检查显示7.0%的患者膀胱粘膜浸润，所有患者均表现为mri定义的膀胱壁浸润。没有mri定义的膀胱壁浸润的患者在膀胱镜/细胞学检查中没有粘膜浸润。中位随访时间为32个月：46.7%的患者出现复发，23.4%的患者出现cc相关死亡。在logistic回归中，mri定义的膀胱壁浸润是肿瘤复发（OR 2.24, p = 0.047）和死亡率（OR 3.55, p = 0.006）的独立危险因素，而膀胱镜定义的膀胱粘膜浸润不是。对数秩检验显示，有和没有mri定义的膀胱壁侵犯的患者的生存率有显著差异（χ²= 15.40,p = 0.0001）。结论：mri定义的膀胱壁侵犯是宫颈癌患者预后不良的一个独立因素。mri诊断的宫颈癌患者膀胱壁浸润对疾病复发和生存的预后意义尚不清楚。结果：MRI发现的膀胱壁浸润是肿瘤复发和肿瘤特异性死亡率的独立预测因子，而膀胱镜检查发现的粘膜浸润则不是。与临床相关的MRI可以安全地取代膀胱镜检查对宫颈癌患者进行术前分期。这种方法可以降低成本并加快分期过程。

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Preoperative staging of cervical cancer: time to shift from cystoscopy to MRI.

Objectives: To evaluate the impact of MRI-defined bladder wall invasion from uterine cervical cancer (CC) on disease recurrence and overall survival.

Materials and methods: IRB-approved multicenter retrospective study including women who underwent staging MRI for histologically confirmed CC (Jan 2015-Dec 2020). Image analysis was independently performed by two radiologists. Bladder wall invasion was diagnosed if ≥ 3 of the following criteria were met: loss of the cervix-bladder fat plane, bladder wall thickening, loss of bladder wall T2-hypointensity, and presence of endoluminal tumor growth. MRI findings were compared with endoscopy/cytology. The impact of MRI-defined bladder wall invasion on tumor recurrence and survival was assessed using logistic regression. Survival curves were compared using the log-rank test.

Results: We included 214 women with a median age of 55 (IQR 47-65) years. MRI-defined bladder wall invasion was observed in 21.5% of patients. Cystoscopy revealed bladder mucosal infiltration in 7.0% of patients, all of whom demonstrated MRI-defined bladder wall invasion. No patients without MRI-defined bladder wall invasion showed mucosal infiltration on cystoscopy/cytology. The median follow-up was 32 months: 46.7% of patients had recurrence, and 23.4% had CC-related death. On logistic regression, MRI-defined bladder wall invasion was an independent risk factor for tumor recurrence (OR 2.24, p = 0.047) and mortality (OR 3.55, p = 0.006), whereas cystoscopy-defined bladder mucosa infiltration was not. The log-rank test demonstrated a significant difference in survival between patients with and without MRI-defined bladder wall invasion (χ² = 15.40, p = 0.0001).

Conclusions: MRI-defined bladder wall invasion represents an independent negative prognostic factor in patients with cervical cancer.

Key points: Question The prognostic significance of MRI-defined bladder wall invasion in patients with cervical cancer remains unclear with respect to disease recurrence and survival. Findings Bladder wall invasion identified on MRI is an independent predictor of tumor recurrence and tumor-specific mortality, whereas mucosal infiltration detected via cystoscopy is not. Clinical relevance MRI can safely replace cystoscopy in the preoperative staging of patients with uterine cervical cancer. This approach can reduce costs and expedite the staging process.

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来源期刊

European Radiology 医学-核医学

CiteScore

11.60

自引率

8.50%

发文量

874

审稿时长

2-4 weeks

期刊介绍： European Radiology (ER) continuously updates scientific knowledge in radiology by publication of strong original articles and state-of-the-art reviews written by leading radiologists. A well balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes ER an indispensable source for current information in this field. This is the Journal of the European Society of Radiology, and the official journal of a number of societies. From 2004-2008 supplements to European Radiology were published under its companion, European Radiology Supplements, ISSN 1613-3749.