Acta Academiae Medicinae Sinica

Abstract: Objective To explore the low-risk indicators of early cervical cancer. Methods The medical records of 201 patients undergoing radical surgery between March 2000 and April 2011 for staging Ia2，Ib1(tumor diameter≤2cm)cervix cancer were retrospectively reviewed, with particular focus on the pathological findings [parametrial involvement, positive margin, positive pelvic lymph node, and lymph vascular space invasion (LVSI)], treatment, and outcomes. Results The operation duration ranged 75-330min (mean:188.87min) and the intra-operative blood loss was approximately 100-2500 ml (mean: 583.33 ml). Pathology showed the rate of parametrial spread, positive margins, lymph node metastasis, LVSI was 0, 6.97%, 12.44%, and 17.41%. Based on the pathologic findings，the patients were classified as two groups: group A had 147 patients(73.13%) with no neoplasm or tumor diameter ≤2 cm，while group B had 54 patients(26.87%)with tumor diameter ＞2 cm. The incidence of ≥1/2 cervical stromal invasion，LVSI，positive lymph node，underlying section of uterus involvement，and low tumor differentiation in group A and B were 20.14% vs. 85.19%(p=0.000), 13.61% vs. 27.78%(p=0.019)，9.52% vs. 20.37%(p=0.039)，4.82% vs. 14.81%(p=0.008)，and 35.37% vs. 44.44%(p=0.025)，respectively，with significant differences. Among the 163 patients who were followed up for more than 3 months，10(6.13%)developed recurrence whereas no patient died. Conclusions Pathologic parametrial involvement in clinical stage Ⅰa2 and Ⅰb1 cervical cancer is uncommon. Tumor size and cervical stromal invasion can be used to identify low-risk population that are worthy of consideration for studies of less radical surgery performed in conjunction with pelvic lymphadenectomy.

Key words: cervical cancer, less radical hysterectomy, preoperative assessment, high risk factor