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Utility of parametrectomy for early stage cervical cancer treated with radical hysterectomy †
Article first published online: 25 JUL 2007
Copyright © 2007 American Cancer Society
Volume 110, Issue 6, pages 1281–1286, 15 September 2007
How to Cite
Wright, J. D., Grigsby, P. W., Brooks, R., Powell, M. A., Gibb, R. K., Gao, F., Rader, J. S. and Mutch, D. G. (2007), Utility of parametrectomy for early stage cervical cancer treated with radical hysterectomy . Cancer, 110: 1281–1286. doi: 10.1002/cncr.22899
Presented at the Society of Gynecologic Oncologists 38th Annual Meeting on Women's Cancer, March 3–7, 2007, San Diego, California.
- Issue published online: 31 AUG 2007
- Article first published online: 25 JUL 2007
- Manuscript Accepted: 25 APR 2007
- Manuscript Revised: 20 APR 2007
- Manuscript Received: 20 FEB 2007
- cervical cancer;
- radical hysterectomy
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.
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.
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%.
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.