Survival for stage IB cervical cancer with positive lymph node involvement: a comparison of completed vs. abandoned radical hysterectomy.
OBJECTIVE
Management for stage IB cervical cancer with intraoperative positive pelvic lymph nodes (LNs) is controversial. We compare 5-year survival rates for women with completed vs. abandoned radical hysterectomy (RH) who were treated with postoperative radiation therapy (RT).


METHODS
We identified all women diagnosed with stage IB cervical carcinoma from the Surveillance, Epidemiology, and End Results database from 1988-1998. Women with positive LN involvement who had undergone a complete pelvic and para-aortic lymphadenectomy were compared for 5-year survival based on whether a RH was completed or abandoned at the time of surgery. All women then received postoperative RT. Survival rates were calculated using the Kaplan-Meier method, and the Chi square test was used for all univariate analysis.


RESULTS
From a cohort of 3116 women diagnosed with stage IB cervical cancer, 265 (8.7%) had positive pelvic LNs and a complete pelvic and para-aortic lymphadenectomy. Of these women, 163 had completion of their RH while RH was abandoned in 55. Positive pelvic LNs averaged 2.58+/-2.37 in the completed RH group and 2.42+/-1.63 in the abandoned RH group. Median follow-up was 6.42 years in the completed RH group and 5.75 years in the abandoned RH group. Five-year survival for the completed RH group was 69% compared with 71% in patients with abandoned RH (p=0.46).


CONCLUSIONS
Treatment for patients with positive pelvic LNs at the time of RH should be determined by overall morbidity of therapy since equivalent 5-year survival was found between the completed and abandoned RH groups.
Richard
Scott D
SD
Division of Gynecologic Oncology, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA.
Krivak
Thomas C
TC
Castleberry
Anthony
A
Beriwal
Sushil
S
Kelley
Joseph L
JL
Edwards
Robert P
RP
Sukumvanich
Paniti
P
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*