Prognostic factors of stage IB and IIA carcinoma of the cervix treated by surgery

Objective To evaluate prognostic factors in patients with stage ⅠB-ⅡA of cervical carcinoma treated by surgery. Methods Between December 1992 and December 2001, 111 patients with stage ⅠB-ⅡA cervical cancer surgically treated were analyzed. Median age 40 years. According to 1994 FIGO Staging System: ⅠB 80 (ⅠB1 40,ⅠB2 40) and ⅡA 31. There were 93 cases of squamous cell carcinoma (83.5%), 17 cases of adenocarcinoma (15.3%) and one case of small cell carcinoma. All patients were treated by radical hysterectomy and pelvic lymphadenectomy, 74 patients had preoperative adjuvant radiotherapy, 24 patients had postoperative adjuvant treatment. Kaplan-Meier method was used to evaluate the survival, the related prognostic factors were assessed by Cox regression and χ 2 test. Results The overall 5- year survival rate was 85.9%, being 89.1%, 90.7% and 78.4% for stage ⅠB1, ⅠB2 and ⅡA, respectively. Univariate analysis showed that tumor size (hazards ratio =1.479, P=0.152), tumor type (HR=1.440, P=0.264), clinical stage (HR=1.380, P= 0.354), adjuvant treatment (HR=1.210, P=0.450), lymph node metastasis (HR=1.432, P=0.540 ), endocervical involvement (HR=2.244, P=0.036), depth of myometrial invasion (HR=3.295,P=0.06) and multiple sexual partners during pregnancy (HR=10.172, P=0.000) were of prognostic significance. The latter two were the most important factors indicative of poor prognosis. Conclusion The depth of myometrial invasion and multi-partners combined with pregnancy are closely related to the prognosis while the pre-and/or postoperative adjuvant therapy should be considered for stage ⅠB-ⅡA cervical cancer with deep myometrial invasion and in pregnant patients with multiple sexual partners.