The prognostic factors for patients with stage I B cervical squamous cell carcinoma treated by radical hysterectomy and radiotherapy

Abstract

Objective To analyze the disease-free survival （DFS） and prognostic factors for stage IB cervical squamous cell carcinoma treated by radical hysterectomy. Methods From January 1999 to December 2005, a total of 206 patients with uterus cervical squamous cell carcinoma were retrospectively analyzed. All the patients were treated by type 3 hysterectomy and pelvic and/or para-aortic lymphadenectomy at Cancer Hospital, Chinese Academy of Medical Sciences. The diseases were stage I B1 and I B2 in 103 patients each. Seventy-nine （76.7%） patients had preoperative radiotherapy and 111 （53. 9% ） had postoperative adjuvant treatment （PosAT）. Prognostic factors were analyzed using univariate model and multivariate Cox model. Results The follow-up rate was 92. 7%. 106 patients had following-up time of five years. The overall 5-year survival rate and the disease-free survival rate of stage Is, Is, and IB2 were 96. 3% and 86. 8%, 100% and 94. 6%, 92. 2% and 77.9%, respectively. Univariate predictors of DFS included tumor size （ FIGO stage, 77.9% ： 94. 6% ; χ^2 = 5.58, P = 0. 018 ）, lympho-vascular space involvement （ LVSI, 74.6% ： 89. 8% ; χ^2 = 10.44, P = 0. 001 ）, vaginal involvement （ purely fornix involvement was not included disease, 50% ： 87.9% ; X2 = 7. 01, P = 0. 008 ） , parametrial involvement （ PI, χ^2 = 17.69 ,P = 0. 000 ）, and metastatic lymph nodes （ LNM ） 〉 2 （ χ^2= 21.47, P = 0. 000 ） in stage IB disease, while LVSI （ χ^2 = 6. 35, P = 0. 012）, PI （χ^2 = 90. 00,P = 0. 000） and LNM 〉 2 （ χ^2 = 26.27, P = 0. 000） in stage IB1 disease, LVSI （ χ^2= 10. 12, P = 0. 001 ）, cervical canal involvement （ χ^2 = 4. 60, P = 0. 032）, vaginal involvement （ χ^2 = 5.87, P = 0. 015 ）, PI （ χ^2= 4. 78, P = 0. 029 ） and LNM 〉 2 （ χ^2 = 6. 72,P=0. 010） in stage IB2 disease. In multivariate analysis, FIGO stage （χ^2 =4. 73,P =0. 030）, LVSI （ χ^2 = 9. 81, P = 0. 002 ）, and LNM 〉 2 （χ^2 = 6. 30, P = 0. 012 ） were significantly associated with DFS in stage Is, while LVSI （ χ^2= 6. 38, P = 0. 012 ） and LNM 〉 2 （ χ^2= 3.92, P = 0. 048 ） were significantly associated with DFS in stage Is2, Conclusions LVSI is an important prognostic factor for stage IB1 cervical cancer. PosAT reduces the recurrences in stage IB2 desease. When PosAT is needed, preoperative radiotherapy can not improve DFS. PosAT should not be commonly used for stage IB1 disease with only deep muscularis invasion. Key words: Uterine cervical neoplasms/surgery; Uterine cervical neoplasms/radiotherapy; Prognosis