High-risk group in node-positive patients with stage IB, IIA, and IIB cervical carcinoma after radical hysterectomy and postoperative pelvic irradiation

Objective. The goal of this study was to identify risk factors in patients with node-positive stage IB, IIA, and IIB cervical carcinoma after radical hysterectomy with pelvic lymph node dissection and postoperative irradiatio n. Methods. Two hundred forty-two patients with FIGO stage IB, IIA, and IIB ce rvical carcinoma underwent radical hysterectomy with pelvic lymph node diss ection; pathological analysis of the surgical specimen showed positive lymp h nodes in 59 patients. These 59 patients were further treated with postope rative radiotherapy. Eighteen patients were in stage IB, 4 in stage IIA, an d 37 in stage IIB. Histological tumor type, tumor size, lymph-vascular spac e invasion, parametrium infiltration, number of positive nodes, and involve ment of common iliac nodes were assessed for correlation with cancer recurr ence. Results. When all these variables were assessed in the Cox proportional reg ression analysis, parametrium infiltration (P = 0.0199) and number of posit ive nodes (two or more nodes) (P = 0.0483) revealed the factor correlating significantly with disease-specific survival. Based on these two factors, n ode-positive patients could be divided into low-risk (n = 11), intermediate -risk (n = 29), and high-risk (n = 19) groups. The 5-year disease-specific survival for the low-risk group was 100% which was significantly better tha n the 39.1% for the high-risk group (P = 0.0012). Conclusion. For patients in the high-risk group, it may be worthwhile to co nsider new strategies to improve survival. (C) 2000 Academic Press.