title: Is parametrectomy always necessary in early-stage cervical cancer?
abstract: Increasing data suggest that patients with early-stage cervical cancer and favorable pathological characteristics have a low risk of parametrial invasion (PI) and benefit from less radical surgery. Our aim was to evaluate the clinical-pathological factors that are related to PI and identify a group of patients who are at low risk for PI.
  
  
  
  We analyzed a series of 345 patients with stage Ia2 to Ib2 cervical cancer, for which they underwent radical surgery from January 1990 to October 2016 at AC Camargo Cancer Center. Chi-square and Fisher's exact tests were used to analyze the correlations between PI and clinicopathological variables.
  
  
  
  A total of 217 (62.9%) patients were classified as having squamous cell carcinoma, and 128(37.1%) had adenocarcinoma or adenosquamous carcinoma. Sixteen (4.6%) patients had PI. The presence of perineural invasion (p=0.003), tumor size >2cm (p=0.044), depth of invasion >10mm (p=0.004), the presence of lymphovascular space invasion(LVSI) (p<0.001), and lymph node metastasis (p<0.001) were related to PI. However, only LVSI (p=0.043) and lymph node metastasis (p<0.001) remained risk factors for PI in the multivariate analysis. Of the patients with tumors ≤2cm and no LVSI, only 1(1.2%) had PI; however, this patient had lymph node metastasis and deep stromal invasion (>10mm). No patient with tumor size ≤2cm and negative lymph nodes had PI.
  
  
  
  Patients with tumors ≤2cm and those who lack LVSI are unlikely to have PI, unless lymph node metastasis or deep stromal invasion is present. Our data can help select patients in whom a more conservative approach is warranted, such as simple hysterectomy and simple trachelectomy that is associated with pelvic lymphadenectomy.
authors.affiliation: Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil. Electronic address: glbaiocchi@yahoo.com.br.
authors.forename: Glauco
authors.initials: G
authors.lastname: Baiocchi
authors.affiliation: Department of Anatomic Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil.
authors.forename: Louise
authors.initials: L
authors.lastname: de Brot
authors.affiliation: Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
authors.forename: Carlos Chaves
authors.initials: CC
authors.lastname: Faloppa
authors.affiliation: Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
authors.forename: Henrique
authors.initials: H
authors.lastname: Mantoan
authors.affiliation: Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
authors.forename: Matheus Rodrigues
authors.initials: MR
authors.lastname: Duque
authors.affiliation: Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
authors.forename: Levon
authors.initials: L
authors.lastname: Badiglian-Filho
authors.affiliation: Department of Medical Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
authors.forename: Alexandre Andre Balieiro Anastacio
authors.initials: AABA
authors.lastname: da Costa
authors.affiliation: Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
authors.forename: Lillian Yuri
authors.initials: LY
authors.lastname: Kumagai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult
keywords: Cervical cancer; Less radical surgery; Parametrial invasion