title: Safe criteria for less radical trachelectomy in patients with early-stage cervical cancer: a multicenter clinicopathologic study.
abstract: BACKGROUND
  To determine the safe criteria for less radical trachelectomy to treat patients with early-stage cervical cancer.
  
  
  METHODS
  We reviewed medical records and pathologic slides of 65 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA-IB1 cervical cancer. The safe criteria for less radical trachelectomy were determined by using three factors such as tumor size ≤ 1 cm, stromal invasion ≤ 5 mm, and no lymphovascular space invasion (LVSI) for minimizing parametrial involvement, lymph node metastasis (LNM), and the need of adjuvant radiotherapy. The diagnostic values were investigated by calculating specificity, negative predictive value for no parametrial involvement, no LNM, and no need of adjuvant radiotherapy.
  
  
  RESULTS
  The median age was 32 years (range 22-44 years), and the median duration of follow-up was 26 months (range 2-103 months). Among seven single or combined factors for the safe criteria, (1) tumor size ≤ 1 cm, (2) tumor size ≤ 1 cm and stromal invasion ≤ 5 mm, (3) tumor size ≤ 1 cm and no LVSI, (4) tumor size ≤ 1 cm, stromal invasion ≤ 5 mm, and no LVSI did not show parametrial involvement, LNM, and the need of adjuvant radiotherapy. In particular, tumor size ≤ 1 cm showed the highest specificity (28.1-29.5%) and negative predictive value (100%). In spite of no difference in progression-free survival (PFS) between tumor size ≤ 1 cm and >1 cm (P = 0.22), tumor size ≤ 1 cm showed better PFS without disease recurrence than tumor size >1 cm (2-year PFS, 100% vs. 90%).
  
  
  CONCLUSIONS
  Less radical trachelectomy may be safe in patients with early-stage cervical cancer who have tumor size ≤ 1 cm.
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hee Seung
authors.initials: HS
authors.lastname: Kim
authors.forename: Chel Hun
authors.initials: CH
authors.lastname: Choi
authors.forename: Myong-Chul
authors.initials: MC
authors.lastname: Lim
authors.forename: Suk-Joon
authors.initials: SJ
authors.lastname: Chang
authors.forename: Yong Beom
authors.initials: YB
authors.lastname: Kim
authors.forename: Min A
authors.initials: MA
authors.lastname: Kim
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Kim
authors.forename: Sang-Yoon
authors.initials: SY
authors.lastname: Park
authors.forename: Byoung-Gie
authors.initials: BG
authors.lastname: Kim
authors.forename: Yong Sang
authors.initials: YS
authors.lastname: Song
authors.forename: Duk-Soo
authors.initials: DS
authors.lastname: Bae
authors.forename: Jae Weon
authors.initials: JW
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D059247:Fertility Preservation; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult