Parametrial involvement in radical hysterectomy specimens for women with early-stage cervical cancer.
OBJECTIVE
To estimate the incidence of parametrial involvement and to evaluate factors associated with parametrial spread in women with early-stage cervical cancer and to identify a cohort of patients at low risk for parametrial spread who may benefit from less radical surgery.


METHODS
We reviewed all patients who underwent radical hysterectomy and pelvic lymphadenectomy for invasive cervical cancer between 1990 and 2006. All women with squamous, adenocarcinoma, or adenosquamous disease, stage IA2-IB1, who underwent completed radical hysterectomy were included in the analysis. Normally distributed continuous variables were compared using Student's t-test for independent samples to analyze the outcome of positive or negative parametrial involvement.


RESULTS
Three hundred fifty patients met the inclusion criteria. Overall, 27 women (7.7%) had parametrial involvement. The majority of specimens with parametrial involvement (52%) had tumor spread through direct microscopic extension. Patients with parametrial involvement were more likely to have a primary tumor size larger than 2 cm (larger than 2 cm: 14%, smaller than 2 cm: 4%, P=.001), higher histologic grade (grade 3: 12%, grades 1 and 2: 3%, P=.01), lymphovascular space invasion (positive: 12%, negative: 3%, P=.002), and metastasis to the pelvic lymph nodes (positive: 31%, negative: 4%, P<.001). One hundred twenty-five women (36%) had squamous, adenocarcinoma, or adenosquamous lesions, all grades, with primary tumor size 2 cm or smaller and no lymphovascular space invasion. In this group of patients, there was no pathologic evidence of parametrial involvement.


CONCLUSIONS
We were able to retrospectively identify a cohort of women with early-stage cervical cancer who were at very low risk for parametrial involvement. If prospective application of these findings confirms our results, less radical surgery-such as simple hysterectomy, simple trachelectomy, or conization-with pelvic lymphadenectomy may be a reasonable therapeutic option for women with primary tumors 2 cm or smaller and no lymphovascular space invasion.


METHODS
III.
Frumovitz
Michael
M
From the Departments of Gynecologic Oncology and Pathology, the University of Texas M. D. Anderson Cancer Center, Houston, Texas; and the Gynecologic Oncology Service, Hospital de Clinicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos 2350, Porto Alegre, Brazil.
Sun
Charlotte C
CC
Schmeler
Kathleen M
KM
Deavers
Michael T
MT
Dos Reis
Ricardo
R
Levenback
Charles F
CF
Ramirez
Pedro T
PT
D000230:Adenocarcinoma / Q000473:pathology; D000328:Adult; D000368:Aged; D018196:Carcinoma, Adenosquamous / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000473:pathology; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D014599:Uterus / Q000473:pathology*