The potential for less radical surgery in women with stage IA2–IB1 cervical cancer

Abstract Objective To identify a subset of patients with stage IA2–IB1 cervical cancer and small tumors (≤ 2 cm) who could be suitable for less radical surgery. Methods In a retrospective study, the medical records of women treated at nine hospitals in China were reviewed. Included women had undergo...

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Bibliographic Details
Published in:International journal of gynecology and obstetrics 2015-09, Vol.130 (3), p.235-240
Main Authors: Bai, Huimin, Yuan, Fang, Wang, Huilan, Chen, Jie, Cui, Quancai, Shen, Keng
Format: Article
Language:English
Subjects:
Adenocarcinoma - pathology
Adenocarcinoma - surgery
Adult
Aged
Carcinoma, Squamous Cell - pathology
Carcinoma, Squamous Cell - surgery
Cervical cancer
China
Female
Humans
IA2–IB1
Less radical
Lymph Node Excision
Lymphatic Metastasis
Middle Aged
Neoplasm Invasiveness
Neoplasm Staging
Obstetrics and Gynecology
Prognosis
Retrospective Studies
Risk factor
Risk Factors
Surgery
Survival Rate
Uterine Cervical Neoplasms - pathology
Uterine Cervical Neoplasms - surgery
Young Adult
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Summary:Abstract Objective To identify a subset of patients with stage IA2–IB1 cervical cancer and small tumors (≤ 2 cm) who could be suitable for less radical surgery. Methods In a retrospective study, the medical records of women treated at nine hospitals in China were reviewed. Included women had undergone radical hysterectomy and pelvic lymph node dissection. The clinicopathologic factors associated with uterine isthmus invasion (UII), vaginal invasion (VI), parametrial invasion (PI), lymph node metastasis (LNM), and prognosis were analyzed. Results Overall, 1632 women were included. Tumor size greater than 2 cm (measured postoperatively) was an independent predictor of VI ( P = 0.002), PI ( P = 0.001), and UII ( P = 0.021). Squamous cell carcinoma and superficial stromal invasion were associated with a low frequency of UII ( P < 0.001 for both). Among patients with adenocarcinoma, deep stromal invasion and lymphovascular space involvement (LVSI) were independently associated with UII ( P = 0.006 and P = 0.004, respectively). Grade 2/3 disease ( P = 0.009), deep stromal invasion ( P = 0.015), and LVSI ( P < 0.001) were independently associated with LNM. LNM was the only independent adverse factor for survival ( P < 0.001). Conclusion Women with stage IA2–IB1 cervical cancer with low-risk factors could be candidates for large-scale prospective clinical trials of less radical surgery and lymphadenectomy omission.
ISSN:0020-7292
1879-3479
DOI:10.1016/j.ijgo.2015.03.042