CLOSE VAGINAL MARGINS AS A PROGNOSTIC FACTOR AFTER RADICAL HYSTERECTOMY

From 1965 to 1995, at the University of Miami/Jackson Memorial Medical Center, 1223 patients with stage IA2, IB, or IIA cervical cancer have undergone a radical hysterectomy. The charts of these patients were r eviewed retrospectively for pathology reports showing positive or clos e surgical margins. Fifty-one of these cases had final pathology resul ts interpreted as close vaginal margins (CVM), which we define as tumo r less than or equal to 0.5 cm from the vaginal margins of resection. All slides of blocks with close vaginal margins were found and reviewe d by a single pathologist. Twenty-eight (54.9%) had parametrial involv ement or positive lymph nodes and received adjuvant radiation therapy (RT). Of the remaining 23 cases, only 6 had other high risk factors, t umor greater than 4 cm, poorly differentiated, greater than 50% invasi on, or lymphovascular space involvement. Sixteen of 23 received radiat ion. The 5-year survival was significantly greater with RT, 81.3%, tha n without RT, 28.6% (P < 0.05). The recurrence rate was also decreased from 85.7 to 12.5% (P < 0.01). Although present in less than 2% of ra dical hysterectomy specimens, CVM without other high risk factors may be an important prognostic variable that should be considered when mak ing adjuvant therapy decisions. (C) 1998 Academic Press.