Elsevier

Obstetrics & Gynecology

Volume 102, Issue 3, September 2003, Pages 612-619
Obstetrics & Gynecology

Original research
Lymphovascular and perineural invasion in the parametria: a prognostic factor for early-stage cervical cancer

https://doi.org/10.1016/S0029-7844(03)00569-6Get rights and content

Abstract

Objective

To estimate the impact of parametrial lymphovascular and perineural involvement on nodal metastasis and failure pattern of women with early-stage, surgically treated cervical cancer.

Methods

Clinical records and pathologic slides of 93 patients with early-stage cervical cancer (2 IA2, 52 IB1, 31 IB2, and 8 IIA) treated with radical hysterectomy and pelvic lymphadenectomy with or without paraaortic lymphadenectomy were reviewed. The study group comprised 80 patients with squamous cell carcinoma and 13 patients with adenocarcinoma of the cervix. Median follow-up time was 33 months. The association among the various histopathologic predictors of outcome was determined with χ2 analysis. The influence of the predictors on outcome was examined with log rank survival methods and the Cox regression model.

Results

The presence of parametrial lymphovascular space invasion is a predictor of disease in the pelvic (P < .001) and paraaortic (P < .05) lymphatics independently. Large tumor size (greater than 4 cm), parametrial perineural invasion, cervical lymphovascular space invasion, and tumor depth (greater than two thirds) were found to be simultaneous predictors of recurrence on multivariate analysis (P < .05). Using these four binary predictor variables, we have computed a model-based relative risk. Based on this model, the presence of perineural invasion in the parametria more than doubles the risk of recurrence in the cohort of patients with large (greater than 4 cm) tumors (P < .05). In a subset analysis of patients with negative nodal disease, parametrial perineural invasion and tumor size were independent predictors of poor outcome (P < .05).

Conclusion

Presence of parametrial lymphovascular space invasion correlates significantly with the risk of nodal metastasis in women with early-stage cervical cancer. Parametrial perineural invasion is an independent poor prognostic factor. Histopathologic findings within the parametria are a valuable independent predictor of recurrence and thus may influence the selection of patients for adjuvant treatment.

Section snippets

Materials and methods

A total of 93 patients with a diagnosis of early stage (IA2–IIA) cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy with or without paraaortic lymphadenectomy between 1975 and 2001 were identified at three different medical centers: University of California Los Angeles, Oliview-UCLA, and Kaiser Permanente Los Angeles. Patients were considered eligible for this study if they had a diagnosis of early-stage cervical cancer (IA2–IIA) and underwent primary surgery by a

Results

The median age in the study population was 46 years (range, 22–75). Median follow-up time was 33 months (range, 1–250). The study group comprised 93 patients. Of these, 80 patients (86%) had squamous cell carcinoma and 13 (14%) had adenocarcinoma of the cervix. All patients had early-stage cervical cancer (2 IA2, 52 IB1, 31 IB2, and 8 IIA) and underwent a radical hysterectomy and pelvic lymphadenectomy. Paraaortic lymphadenectomy was performed in 54 (58%) patients. Bilateral

Discussion

The significance of parametrial resection in the operative management of patients with cervical cancer has led to the evolution of the surgical techniques used in managing these patients. Simple vaginal hysterectomy was first performed, leading to poor results. In 1893, Schuchardt resected parametrial tissue in addition to the uterus via a vaginal technique and observed a marked improvement in outcome.5 A more extensive parametrial resection and ureteral dissection through an abdominal approach

Acknowledgements

The authors thank Jeffrey Gornbein, DrPH, and Susan Service, MS, of the Department of Biomathematics, David Geffen School of Medicine at UCLA for their assistance with the statistical analysis.

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