Utility of parametrectomy for early stage cervical cancer treated with radical hysterectomy

Abstract

BACKGROUND. Removal of the parametrial soft tissue is recommended for patients with cervical cancer undergoing radical hysterectomy. Parametrectomy results in significant morbidity. The objective of the study was to determine factors predictive of parametrial tumor spread and to define a subset of patients at low risk for parametrial disease. METHODS. Patients with invasive cervical cancer who underwent radical hysterectomy from 1989–2005 were examined. Analysis was performed to determine factors associated with parametrial tumor spread. Survival estimates were determined using the Kaplan‐Meier method. RESULTS. A total of 594 patients were identified. Parametrial metastases were documented in 64 (10.8%). Factors associated with parametrial disease were: histology, advanced grade, deep cervical invasion, lymphovascular space invasion (LVSI), large tumor size, advanced stage, uterine or vaginal involvement, and pelvic or para‐aortic lymph node metastases (P < .0001 for each). Parametrial metastases were associated with increased risk of recurrence and decreased disease‐free and overall survivals (P < .0001). A subgroup analysis was performed to identify patients at low risk for parametrial spread. In pelvic node‐negative women parametrial disease was noted in 6.0% (30/498) compared with 47.9% (34 of 71) of those with positive pelvic nodes (P < .0001). If further stratified to women with negative nodes, no LVSI, and tumors < 2 cm, the incidence of parametrial disease was only 0.4%. CONCLUSIONS. Parametrial spread is a strong predictor of recurrence and decreased survival. Parametrial invasion is rare in patients with small tumors, no LVSI, and negative pelvic nodes (no poor prognostic factors). Further study is warranted to determine the feasibility of omitting parametrectomy in these low‐risk patients. Cancer 2007. © 2007 American Cancer Society.

Clinical and Pathological Factors Related to the Prognosis of Chinese Patients with Stage Ⅰb To Ⅱb Cervical Cancer

“…Wright et al suggested that parametrial tissue infiltration could increase the risk of tumor recurrence and shorten DFS and OS (Wright et al, 2007). Munagala et al found that the number of parametrial invasion was the sole factor that affected OS and DFS, and the 5-year survival of patients with bilateral parametrial invasion was significantly lower than that of patients with unilateral parametrial infiltration (Munagala et al, 2010).…”

“…Annually, it is estimated that 493,000 women worldwide will be diagnosed with cervical cancer and that 273,000 will die from the disease (Wright et al, 2007). In China, there will be about 130,000 new cases of cervical cancer diagnosed and about 30,000 women who will die from the disease every year.…”

Compromiso parametrial en pacientes con cáncer de Cérvix IB-1 tratadas con histerectomía radical en Perú

“…Este valor está dentro del rango reportado por otras investigaciones en poblaciones similares (que son del 2,4 al 10,9% (18,20,21) ). Lo que implica que se podría realizar en forma segura un procedimiento quirúrgico menos radical en un subgrupo de estas pacientes.…”

“…Se encontró que el estado ganglionar linfático pélvico es el predictor independiente más fuerte para presentar CP, conjuntamente con la profundidad de infiltración. Este factor ha sido previamente reportado como un predictor sólido de propagación parametrial (7,18,(21)(22)(23)(24)(25)(26)(27)(28) .…”

“…Sin embargo, no está claro si el subgrupo de tumores que fueron clasificados como "otros" incluyó histología de alto riesgo como carcinoma de células claras, melanoma o tumores neuroendocrinos (21) . No se encontró estas últimas histologías en esta serie, pero sí se halló tumores adenoescamosos, una histología más agresiva que los adenocarcinomas o lesiones epidermoides (26) .…”