Abstract
We aimed to identify factors predicting parametrial invasion in early-stage cervical cancer patients undergoing radical hysterectomy. We recruited women with invasive cervical cancer who underwent radical hysterectomy at a single medical institute from 2000–2011. The clinical and pathological characteristics and outcomes were retrospectively recorded, and the risk factors for parametrial invasion were analyzed. We enrolled 339 patients, including 7 with stage IA1 carcinomas, 10 with stage IA2, 266 with stage IB1, 39 with stage IB2, 14 with stage IIA1, and 3 with stage IIA2. The majority (237/339, 69.9%) had squamous cell carcinoma, while 32 (12.4%) had parametrial invasion. The 16 patients with stage IB1 tumors and parametrial invasion were older (55.9±9.5vs. 49.0±9.9 years, p = 0.005, Mann-Whitney U test), and had deeper cervical stromal invasion (9.59±4.87 vs. 7.47±5.48 mm, p = 0.048, Mann-Whitney U test), larger tumor size (2.32±1.15 vs. 1.74±1.14cm, p = 0.043, Mann-Whitney U test), higher incidences of lymphovascular space invasion (87.5% vs. 28.8%, p<0.001, chi-square test), and greater lymph node metastasis (68.8% vs. 10.8%, p<0.001, chi-square test) than the 260 patients without parametrial invasion. Among the patients with stage IB1 tumor size >2 cm,10% had parametrial invasion and 24.2% had lymph node metastasis compared with only 4% and 9.4% of stage IB1 patients with a tumor size <2 cm, respectively. Only one (0.9%) of the 109 patients aged less than 50 years had parametrial invasion compared with 6 (9.7%) of the 62 patients aged over 50 years. Patients with stage IA2 and IB1 tumors <2 cm may not need radical hysterectomy owing to the low incidence of parametrial invasion.
Highlights
Cervical cancer has the fourth highest incidence and mortality rate among cancer in women [1]
Patients were eligible if they met the following criteria: (1) they were diagnosed at stage IA2 to IIA2; (2) they were treated with a class II or III radical hysterectomy [16]; (3) they were treated with pelvic lymphadenectomy; (4) the histologic data were reviewed by proficient pathologists specializing in gynecologic oncology; (5) there were sufficient clinico-pathological and survival data regarding disease prognosis; and (6) they were not treated with neoadjuvant chemotherapy or radiotherapy
The approach is to treat the disease with enbloc radical surgery including parametrectomy with negative surgical margins
Summary
Cervical cancer has the fourth highest incidence and mortality rate among cancer in women [1]. The primary treatments for early-stage cervical cancer (stages I and IIA) include radiation and surgery [2,3,4,5,6]. While the prognosis after radical hysterectomy is good, the operation includes parametrectomy, which damages the autonomic nerves traversing through the paracervical region. These nerves include the sympathetic fibers from the hypogastric nerve and parasympathetic fibers from the pelvic splanchnic and inferior hypogastric plexus [7]. Some investigators have attempted to develop nerve-sparing procedures during radical hysterectomy to preserve nerve and bladder function [8, 9]. Such techniques are not yet standardized, and the oncologic therapeutic effect is unclear
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