Low Risk Factors And Feasibility Associated To Early-stage Cervical Cancer With Modified Radical Hysterectomy

Objective:The purpose of the present study is to estimate the incidence of parametrial involvement and to evaluate factors associated with parametrial spread in women with early-stage(IA1-IB1) cervical cancer and to identify a cohort of patients at low risk for parametrial spread who may be possible to undergo modified radical hysterectomy.Methods:We retrospectively reviewed 602 patients with stage IA1-IB1 cervical cancer who had undergone radical hysterectomy and pelvic lymphadenectomy in the obstetrics and gynecology hospital of Fudan university during 2008-2011. We correlated the parametrial metastatic and outcome with various clinicopathologic features, the tumor diameter,the presence of lymphatic invasion,lymph node metastasis,immunohistochemistry results and outcome.Results:The average age of 602 patients is 45.9 years old.According to 2009 International Federation of Gynecology and Obstetric (FIGO) staging standard,522 patients(91.7%) are at IB1,14 patients(2.3%) are at IA2 and 36 patients(6.0%) are at IA1.According to pathology,354 patients’(58.8%)tumor diameter is≤2cm,the incidence of cervical stromal invasion< 1/2 is 61.6%,and 411 (68.3%)patients have no lymphovascular space involvement(LVSI),23patients(3.8%) has parametrial spread. Patients without parametrial involvement were more likely to have a primary tumor diameters samller than 2 cm, stromal invasion< 1/2, no lymphovascular space involvement.Patients with all that three low risk factors are rarely occurs parametrial involvement(0.007%).The median width of parametrial removed is 3 cm. According to the width of parametrial tissue removed,patients are classified as two groups,one group is 258(43.0%)patients’ parametrial tissue width≥3cm,while the other group is 343(57.0%) with the width<3cm in at least one side.Not all patients received Immunohistochemistry test,this study focus on 3 items which may related to the tumor metastasis,602patients who followed up 12～60 months,there are 575(95.5%) still alive,and 27 patients dead in cervical cancer.Conclusion:We were able to retrospectively identify a cohort of women with early-stage cervical cancer who were at very low risk for parametrial involvement.Modified radical hysterectomy with pelvic lymphadenectomy may be a reasonable therapeutic option for women with primary tumors≤2 cm and cervical stromal invasion<1/2 and no lymphovascular space invasion.