SURGICAL PATHOLOGICAL FACTORS THAT PREDICT RECURRENCE IN STAGE IB ANDIIA CERVICAL-CARCINOMA PATIENTS WITH NEGATIVE PELVIC LYMPH-NODES

BACKGROUND, The purpose of this analysis was to identify pathologic ri sk factors for recurrence and patterns of recurrence in patients with International Federation of Gynecology and Obstetrics Stage IB and IIA cervical carcinoma and negative pelvic lymph nodes after radical hyst erectomy. METHODS, During the period 1982-1991, 271 clinically staged patients with Stage IB or IIA cervical carcinoma underwent a Wertheim- Okabayashi radical hysterectomy with pelvic lymph node dissection. The study group was composed of 196 lymph node negative patients. Patholo gy slides were reviewed and multivariate analysis performed to identif y independent prognostic factors. RESULTS, The recurrence rate in the study group was 7.7%. In multivariate analysis, the following factors were identified as independent risk factors for recurrence: adenocarci noma (P = 0.003), depth of invasion as a fraction of tumor penetration of the cervical stroma (P = 0.01), and an extensive stromal inflammat ory cell infiltrate (P = 0.04). Based on these factors, the following risk groups were identified: a low risk group (N = 140, 5-year disease free interval [DFI] = 97%) and a high risk group (N = 55, 5-year DFI = 81%). An evaluation of the recurrence patterns for these patients sh owed a predominance of pelvic recurrences. CONCLUSIONS, This study sho wed that among patients with Stage IB and IIA cervical carcinoma and n egative pelvic lymph nodes, a subset with a significant risk for recur rence could be identified. Because the majority of recurrences in the lymph node negative group were pelvic recurrences, the value of adjuva nt radiotherapy as a treatment for selected lymph node negative patien ts should be evaluated in a prospective study. (C) 1997 American Cance r Society.