title: Parametrial involvement, regardless of nodal status: a poor prognostic factor for cervical cancer.
abstract: OBJECTIVE
  To evaluate the effect of resection of central disease when the parametria are involved by tumor in high-risk stage I cervical cancer patients.
  
  
  METHODS
  Thirty-two patients with high-risk stage I cervical cancer who underwent radical hysterectomy and had pathologic findings of positive lymph nodes (N = 13), positive parametria (N = 7), or both (N = 12) were identified retrospectively. The effects of various histopathologic findings on disease-free interval and survival were evaluated, including the effect of resection of central disease with and without positive nodal disease. Kaplan-Meier survival curves were compared with the log-rang test. Multivariate analyses using a stepwise regression model were performed.
  
  
  RESULTS
  Compared with other histologies, adenocarcinoma was associated with a significantly shorter disease-free interval (P = .037). Among patients with parametrial involvement lymph node status did not affect disease-free interval or survival. However, when patients with positive lymph nodes were examined, the additional finding of parametrial positivity significantly worsened both disease-free interval (P = .039) and survival (P = .036). When the 19 patients with positive parametria, regardless of lymph node status, were compared with those with positive lymph nodes alone, the former group had a significantly shorter disease-free interval (P = .038). The tumor recurred in 12 of these 19 patients; all cases involved the pelvis, with a median time to recurrence of 15 months. Multivariate analysis showed that adenocarcinoma histology (P = .038) and parametrial involvement (P = .043) were independent, poor prognostic indicators for disease-free interval.
  
  
  CONCLUSIONS
  Involvement of the parametria, regardless of lymph node status, and adenocarcinoma histology confer a poor prognosis in high-risk patients undergoing radical hysterectomy. Caution should be used when contemplating resection of bulky tumors as part of primary therapy if the parametria appear to be involved by tumor.
authors.affiliation: Department of Obstetrics and Gynecology, Yale University, School of Medicine, New Haven, Connecticut, USA.
authors.forename: T G
authors.initials: TG
authors.lastname: Zreik
authors.forename: J T
authors.initials: JT
authors.lastname: Chambers
authors.forename: S K
authors.initials: SK
authors.lastname: Chambers
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000328:Adult; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery