Radical hysterectomy for FIGO stage IIB cervical cancer: Clinicopathological characteristics and prognostic evaluation

doi:10.1016/j.ygyno.2009.03.026

Gynecologic Oncology

Volume 114, Issue 1, July 2009, Pages 69-74

https://doi.org/10.1016/j.ygyno.2009.03.026 Get rights and content

Abstract

Objective

To clarify the clinicopathological features and prognostic factors of patients with FIGO stage IIB cervical cancer who were treated with radical hysterectomy.

Methods

One hundred thirty-nine FIGO stage IIB patients with squamous or adenosquamous cell carcinoma (median age, 51 years) who were treated with primary radical hysterectomy were examined retrospectively. Sixty-six FIGO stage IIB patients who were treated with primary radiotherapy (median age, 70 years) were included for comparison of survival.

Results

Fifty percent (70/139) of the patients had pathological parametrial involvement. Among them, the positive rate of pelvic lymph nodes was 71% (50/70). Ninety-nine percent (138/139) of the tumors were completely removed, and the pelvic control rate was 88%. Major complications requiring surgery were found in 2.9% (4/139). Significant differences in survival were found among patients in subgroups according to pathological parametrial involvement, pelvic lymph node status, tumor size, lymph–vascular space invasion, and depth of myometrial invasion (log-rank test, P < 0.05). Of these, the Cox proportional-hazard model revealed that parametrial involvement (P = 0.001, 95% CI 1.992–6.297) and lymph node metastasis (P = 0.042, 95% CI 1.023–3.298) were independent prognostic factors. The 5-year survival rate and relapse-free survival at 36 months were 69% and 72% among the radical hysterectomy group, and 69% and 75% among the radiotherapy group. The Cox model adjusted for age showed no significant differences in survival and relapse-free survival between these two groups.

Conclusion

Pathological parametrial involvement and positive nodes were prognostic factors for surgically treated patients with FIGO stage IIB cervical cancer.

Introduction

International Federation of Gynecology and Obstetrics (FIGO) stage IIB cervical cancer is recognized as a locally advanced-stage disease, and radiotherapy has been widely accepted as the standard treatment of choice. The FIGO Annual Report reported that 72% (2320/3233) of patients with stage IIB disease were treated with radiotherapy, and 11% (340/3233) were treated with surgery as the first therapy between 1996 and 1998 [1]. The U.S. National Institutes of Health recommends radiotherapy with concurrent cisplatin-containing chemotherapy as the primary treatment option in stage IIB patients [2]. These recommendations are based on randomized control phase III trials showing an overall survival advantage of concurrent chemo-radiotherapy in comparison with radiotherapy alone [3], [4], [5], [6], [7]. However, one trial did not show a benefit of adding concurrent weekly cisplatin to radical radiotherapy on either pelvic control or survival [8]. To our knowledge, no randomized control trial showed a difference in survival between patients who received concurrent chemo-radiotherapy and those who received radical hysterectomy among stage IIB patients.

On the other hand, Okabayashi [9] in Japan introduced a surgical procedure for the treatment of cervical cancer in 1921 that was more radical than the conventional Wertheim operation. After Okabayashi introduced his method, gynecologic oncologists in Japan studied and modified his procedure, and radical hysterectomy came to be adopted as one of the standard treatments for stage IIB disease. Based on this historical background, when our division was started in 1962, both primary radiotherapy and radical surgery were employed as treatment options for stage IIB cervical cancer. Generally, we have recommended radical surgery for patients 65 years and under, and radiotherapy for patients over 65 years, based on empirical observations at that time. Few reports on the clinical features of patients with pathologically confirmed findings of stage IIB cervical cancer treated with radical hysterectomy have been published [10]. Clarifying the clinicopathological features of surgically treated stage IIB cervical cancer is useful for discussing the treatment strategy of not only the surgical procedure, but also chemo-radiotherapy for stage IIB disease. We analyzed the clinicopathological characteristics and prognostic factors of stage IIB patients who underwent radical hysterectomy. We also studied stage IIB patients who underwent primary radiotherapy for comparison of survival and complications.

Section snippets

Patients

We reviewed the medical records and pathological materials obtained from 1189 patients with stage IB–IVA primary cervical cancer treated at the Gynecology Division of the National Cancer Center Hospital, Tokyo, Japan, between 1984 and 2003. This study included patients who met the following criteria: the patient had FIGO stage IIB disease; the patient underwent (a) primary surgery consisting of radical hysterectomy with pelvic lymphadenectomy, or (b) primary radiotherapy; and the patient had a

Patient characteristics

Among the 243 patients with stage IIB cervical cancer who were treated in our division during the study period, 205 patients met the study criteria. Reasons for exclusion were adenocarcinoma or other uncommon histological subtype (n = 34), having received preoperative radiotherapy (n = 2), having received preoperative chemotherapy (n = 1), and nonradical hysterectomy (n = 1). Among the 205 patients, 139 patients (age, median 51 years, range 24–78 years) underwent radical hysterectomy, and 66 patients

Discussion

In eight reports in the literature since 1980 including the present study, the incidence of parametrial involvement proven pathologically among patients with FIGO stage IIB disease ranged between 21.5 and 55% [17], [18], [19], [20], [21], [22], [23]. Assessment of parametrial involvement is important because discriminating the true pathological extent of the tumor from inflammatory change, adhesion, fibrosis, and irregular-shaped, large-size cervical tumor is difficult in the FIGO staging

Conflict of interest statement

The authors declare that there are no conflicts of interest.

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Radical hysterectomy for FIGO stage IIB cervical cancer: Clinicopathological characteristics and prognostic evaluation

Abstract

Objective

Methods

Results

Conclusion

Introduction

Section snippets

Patients

Patient characteristics

Discussion

Conflict of interest statement

Int. J. Gynaecol. Obstet.

Am. J. Obstet. Gynecol.

Gynecol. Oncol.

Gynecol. Oncol.

Gynecol. Oncol.

Gynecol. Oncol.

Gynecol. Oncol.

Gynecol. Oncol.

Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB–IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study

J. Clin. Oncol.

Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer

N. Engl. J. Med.

Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer

N. Engl. J. Med.

Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma

N. Engl. J. Med.

Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix

J. Clin. Oncol.

Phase III trial comparing radical radiotherapy with and without cisplatin chemotherapy in patients with advanced squamous cell cancer of the cervix

J. Clin. Oncol.

Radical abdominal hysterectomy for cancer of the cervix uteri

Surg. Gynecol. Obstet.