Is Radical Hysterectomy Necessary in Early Cervical Cancer?
Ruthy Shaco-Levy, Shanny Sade, Jacob Dreiher, Mihai Meirovitz. Soroka University Medical Center, Beer-Sheva, Israel; Ben-Gurion University of the Negev, Beer-Sheva, Israel; Clalit Health Services, Tel-Aviv, Israel
Background: The purpose of this study was to estimate the prevalence of tumor spread to the parametrium, vagina and uterine corpus in radical hysterectomy specimens and define a subgroup of patients with low-risk of extra-cervical involvement, who may benefit from less radical surgery.
Design: We retrospectively reviewed 96 patients with stage IA1-IIA cervical cancer who had undergone radical hysterectomy and pelvic lymphadenectomy.
Results: Tumor spread beyond the uterine cervix was evident in 45 (47%) patients. Thirteen (13%) of the 96 patients had parametrial tumor spread, 12 (13%) had vaginal tumor extension, and 23 (24%) had uterine corpus involvement. Tumor size >2 cm, stromal invasion to a depth of ≥8 mm, lymph vascular space invasion (LVSI), high histological tumor grade, and advanced tumor stage were significantly associated with extra-cervical invasion. In multivariate analysis LVSI, tumor size >2 cm and stromal invasion of ≥8 mm were found to be associated with extra-cervical invasion.
|Odds ratio||Lower||Upper||P value|
|Lymph vascular space invasion (vs. no invasion)||12.5||3.8||40.4||<0.001|
|Tumor size > 2 cm (vs.≤ 2 cm)||5.7||1.6||19.9||0.006|
|Stromal invasion (per 5 mm)||1.9||1.05||3.6||0.033|