title: Early cervical cancer and parametrial involvement: is it significant?
abstract: OBJECTIVE
  To determine the incidence of parametrial involvement in clinical stage IA and IB1 cervical cancer and whether pelvic lymph node status is a predictor of parametrial status.
  
  
  METHODS
  Retrospective review of 120 patients with FIGO stage IA/IB1 cervical carcinoma treated by class II radical abdominal hysterectomy between January 1997 and December 2001 was performed. The parametria were examined for microscopic involvement of parametrial lymph nodes and/or tissue. Continuous variables were compared using Wilcoxon rank sum test, and Fisher's exact test was used to categorical variables. Kaplan-Meier curves were constructed for overall survival (OS) and recurrence-free survival (RFS). Cox proportional hazards model was used to investigate prognostic factors.
  
  
  RESULTS
  One hundred ten patients were eligible. Five patients (5%) had positive parametria and 13 patients (12%) had positive pelvic lymph nodes. Four (80%) patients with positive parametria had positive pelvic lymph nodes. The groups did not differ significantly in terms of age (P = 0.92), histology (P = 0.15), or LVSI (P = 0.20). Positive parametria was associated with larger tumor size (3.0 vs. 2.0 cm, P < 0.05), greater depth of invasion (16 mm vs. 5 mm, P = 0.03), and pelvic lymph node metastases (80% vs. 10%, P = 0.001). The only variable that was significant in the proportional hazards model was lymph node status (P = 0.02). After median follow-up of 48 months, there was a significant difference in recurrence (40% vs. 4%, P = 0.03) and RFS (0.0003).
  
  
  CONCLUSIONS
  Acknowledging small sample size and retrospective study, positive parametrial involvement in stage IA and IB1 cervical cancer is infrequent. There is a significant association with lymph node status. Thus, there may be a role for less radical surgery combined with pelvic lymphadenectomy in this patient population.
authors.affiliation: Department Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alberta, Edmonton, AB, Canada. helenste@cancerboard.ab.ca
authors.forename: H
authors.initials: H
authors.lastname: Steed
authors.forename: V
authors.initials: V
authors.lastname: Capstick
authors.forename: A
authors.initials: A
authors.lastname: Schepansky
authors.forename: L
authors.initials: L
authors.lastname: Honore
authors.forename: M
authors.initials: M
authors.lastname: Hiltz
authors.forename: W
authors.initials: W
authors.lastname: Faught
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery