[1235] 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.

Variables associated with extra-cervical invasion (Multiple Logistic Regression Model, n=94, C-statistic=0.890)
 Odds ratioLowerUpperP value
Lymph vascular space invasion (vs. no invasion)12.53.840.4<0.001
Tumor size > 2 cm (vs.≤ 2 cm)5.71.619.90.006
Stromal invasion (per 5 mm)1.91.053.60.033
95% Confidence Interval

Twenty-five patients had stromal invasion of <8 mm and no LVSI, of which only 1 (4%) had extra-cervical involvement. On the contrary, extra-cervical involvement was evident in 44 patients (63%) among those who had stromal invasion of ≥8 mm and/or LVSI (p<0.001). Among women with LVSI extra-cervical tumor spread was seen with any tumor size and any depth of stromal invasion. All patients with stromal invasion to a depth of >15 mm had extra-cervical invasion.
Conclusions: Patients with tumor size <2 cm, depth of invasion of <8 mm and no LVSI could be considered for less radical surgery.
Category: Gynecologic & Obstetrics

Wednesday, March 6, 2013 1:00 PM

Poster Session VI # 188, Wednesday Afternoon

 

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