Surgical and immunohistochemical (IC) risk factors for metastatic disease in stage IB1 cervical cancer (CC)

Abstract

e16578 Background: Stage IB1 CC is treated with radical abdominal hysterectomy (RH) and pelvic lymph node dissection (LND) because of presumed risk of parametrial and nodal involvement. We sought to identify surgical and IC risk factors for metastatic disease. Methods: Retrospective chart review of all stage IB1 CC patients who underwent RH and LND from 1996–2008. Results: Of the 35 patients identified, 25 (71%) had squamous cell, 9 (26%) adenocarcinoma, and 1 (3%) adenosquamous histology. Median tumor diameter of patients without lymphovascular space involvement (LVI), with LVI, and with positive LN was 1.2, 2.0, and 2.5 cm respectively. Median of 24 LNs was removed. LVI was noted in 13 (37%) patients of whom 5 (38%) had positive LN. None of the 22 patients without LVI had LN involvement. Only 2 of 35 (6%) had parametrial involvement, both of which had positive LN. All patients with positive LN received chemo-radiation. In addition six patients with LVI and deep cervical stromal invasion received adjuvant radiation therapy. Median follow-up was 14 months. Postoperatively 8 (23%) and 4 (11%) patients had early and late complications respectively. There was one (3%) vaginal recurrence in a patient with positive LN. The 5-year progression-free survival and overall survival was 95% and 100%, respectively. Immunohistochemical (IC) staining was performed on 29 cases (10 LVI, 4 positive LN) for bcl-2, p53, Ki-67. There was increased staining for Ki-67 in patients with LVI (61% vs. 44%, p = 0.01), and in those with positive LN (66% vs. 48%, p = 0.04). No correlation was found with p53 or Bcl-2. Conclusions: The rate of LN metastasis in patients with stage IB1 CC is significant (14 %), as is the rate of parametrial involvement (6%). However, it occurred only in patients with LVI. Staining for Ki-67 may help detect high-risk patient. RH followed by adjuvant therapy in high-risk patients resulted in 100% 5-year survival, but is associated with morbidity. No significant financial relationships to disclose.