The role of radical surgery followed by adjuvant therapy for high-risk early-stage cervical carcinoma patients with pelvic lymph node metastasis

Objectives: To identify a subgroup of high-risk node-positive patients in e arly-stage cervical cancers and to determine the role of radical hysterecto my followed by adjuvant therapy to these patients. Study design: We conduct ed a retrospective review of 482 surgically-treated patients of clinical st age Ib and IIa cervical carcinoma from July 1986 to December 1994 at Kaohsi ung Chang Gung Memorial Hospital. Of these, 90 patients had pelvic lymph no de metastases. Clinicopathological variables, including the level of pretre atment squamous cell carcinoma antigen (SCC-Ag), DNA flow cytometry analysi s, and the use of different adjuvant therapies were studied. Results: Disea se-free survival was significantly worse among patients with S-phase Fracti on greater than 20% and pretreatment SCC-Ag level above 5 ng/ml. Utilizing these significant variables, we identified two distinct risk groups. Those patients without any of the risk variables were categorized as the low-risk group. Those patients with either one or both risk variables were categori zed as the high-risk group. Five-year disease-free survival rates were 74% in the low-risk group and 43% in the high-risk group, (P=0.034). Disease re curred in 30.2% of thr low-risk patients and 45.3% of the high-risk patient s. No survival advantages were found by using different adjuvant therapies. Conclusions: Radical hysterectomy should not be attempted if either the pr etreatment SCC-AE level is above 5 ng/ml or S-phase Fraction of the tumor g reater than 20% due to its limited value despite applying aggressive postop erative adjuvant, therapy. (C) 2000 Elsevier Science Ireland Ltd. All right s reserved.