RISK-FACTORS FOR RECURRENCE IN PATIENTS WITH STAGE IB, IIA, AND IIB CERVICAL-CARCINOMA AFTER RADICAL HYSTERECTOMY AND POSTOPERATIVE PELVIC IRRADIATION

Objective: To identify risk factors for cancer recurrence in patients with stage IB, IIA, and IIB cervical carcinoma after abdominal radical hysterectomy with pelvic lymph node dissection and postoperative pelv ic irradiation. Methods: One hundred and eighty-seven patients with ce rvical carcinoma stage IB (n = 63), IIA (n = 43), and IIB (n = 81) dis ease who received abdominal radical hysterectomy with pelvic lymph nod e dissection and postoperative pelvic irradiation were followed-up for 2-10 years. The histologic type, grade, lymphovascular tumor emboli, tumor size, invasion sites, deep cervical stromal invasion, and pelvic lymph node metastases were assessed for correlation with cancer recur rence. Results: Recurrence occurred in 45 cases (24%), of whom 40 had died of the disease at the 5-year follow-up period. Univariate proport ional hazards analysis revealed that the significant risk factors were adenocarcinoma, bulky tumor size (4 cm or greater), lymphovascular tu mor emboli, deep cervical stromal invasion, and lymph node metastases, especially iliac nodal metastases and bilateral nodal metastases. Mul tivariate proportional hazards analysis showed that bulky tumor size ( hazard ratio 2.34), tumor emboli (hazard ratio 2.74) and iliac nodal m etastases (hazard ratio 5.31) remained significant risk factors. In co ntrast, no deaths occurred in the other 142 cases who did not have rec urrence. Conclusion: This retrospective study suggests that stage IB, IIA,and IIB cervical carcinoma cases with the above-mentioned patholog ic factors are at higher risk of recurrence after abdominal radical hy sterectomy with pelvic lymph node dissection and postoperative pelvic irradiation.