title: Class II versus Class III radical hysterectomy in early cervical cancer: an observational study in a tertiary center.
abstract: OBJECTIVE
  The purpose of this observational study was to evaluate disease free survival (DFS), overall survival (OS), and local recurrence rate (LRR) in patients submitted to Class II RH compared with Class III RH in early FIGO stage cervical cancer (ECC).
  
  
  METHODS
  We investigated 127 patients with CC admitted to the National Cancer Institute of Milan from June 2001 to October 2011 treated with Class II RH, and compared them with 202 patients operated with Class III RH between March 1980 and March 2001. A total of 329 patients were collected.
  
  
  RESULTS
  Median follow-up time was 91 months (IQ range:58-196). Five-year OS and DFS estimates were 89.5% (95%CI: 86.0-93.2%) and 85.6% (95%CI: 81.6-89.7%), respectively. Estimates of effect of surgical treatment (Class III RH versus Class II RH) on OS showed a HR of death = 3.38 (95%CI: 1.18-9.63, P = 0.0228), at univariable Cox analysis, and a HR = 3.08 (95%CI: 0.96-9.93; P = 0.0595) at multivariable analysis. For DFS, a HR of relapse = 2.51 (95%CI 1.10-5.72; P = 0.0290) comparing Class III vs Class II was found at multivariable analysis. Overall recurrence rate was 12.8%, whilst it was 16.3% for Class III and 7.1% for Class II respectively.
  
  
  CONCLUSIONS
  The present data suggest that the outcomes of Class II RH are comparable in terms of LRR and OS to those of Class III RH, according to literature data. The opportunity of extending the indication to all women with ECC needs further investigations. Clearer data are warranted by prospective controlled studies.
authors.affiliation: Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy. Electronic address: antonino.ditto@istitutotumori.mi.it.
authors.forename: A
authors.initials: A
authors.lastname: Ditto
authors.affiliation: Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Martinelli
authors.affiliation: Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Ramondino
authors.affiliation: Unit of Clinical Epidemiology and Trial Organisation, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: S L
authors.initials: SL
authors.lastname: Vullo
authors.affiliation: Department of Pathology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Carcangiu
authors.affiliation: Department of Anaesthesiology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Haeusler
authors.affiliation: Unit of Clinical Epidemiology and Trial Organisation, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Mariani
authors.affiliation: Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Lorusso
authors.affiliation: Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Raspagliesi
mesh_terms: D000367:Age Factors; D001707:Biopsy, Needle; D016009:Chi-Square Distribution; D015331:Cohort Studies; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000401:mortality; D007150:Immunohistochemistry; D007558:Italy; D053208:Kaplan-Meier Estimate; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*
keywords: Cervical cancer; Overall/disease free survival; Radical hysterectomy; Recurrence rate; Tailoring radicality