Pathologic Risk Factors and Oncologic Outcomes in Early-stage Cervical Cancer Patients Treated by Radical Hysterectomy and Pelvic Lymphadenectomy at a Thai University Hospital: A 7 year Retrospective Review

  • Ruengkhachorn, Irene (Gynecologic Oncology Division, Department of Obstetrics & Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Therasakvichya, Suwanit (Gynecologic Oncology Division, Department of Obstetrics & Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Warnnissorn, Malee (Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Leelaphatanadit, Chairat (Gynecologic Oncology Division, Department of Obstetrics & Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Sangkarat, Suthi (Gynecologic Oncology Division, Department of Obstetrics & Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Srisombat, Jutatip (Gynecologic Oncology Division, Department of Obstetrics & Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University)
  • Published : 2015.09.02


Background: To evaluate the rate of pathologic high-risk factors, intermediate-risk factors, and treatment outcomes in early-stage cervical cancer patients undergoing radical hysterectomy and pelvic lymphadenectomy (RHPL). Materials and Methods: Medical records of stage IA-IIA1 cervical cancer patients who underwent RHPL during the 2006 to 2012 time period and patient follow-up data until December 2013 were reviewed. Results: Of 331 patients, 52 women (15.7%) had pathologic high-risk factors and 59 women (17.8%) had intermediate-risk factors without high-risk factors. All studied patients had an initial complete response. At median follow-up time of 40.9 months (range 1-103.3 months) and mean follow-up time of$ 43.3{\pm}25.3$ months, 37 women had disease recurrence and 4 women had died of disease. The most common site of recurrence was the pelvis (64.8%). Five-year and 10-year disease free survival rates were 96.1% and 91.5%, respectively. Five-year and 10-year overall survival rates were 100% and 99.4%, respectively. Independent factors related to recurrence were pelvic node metastasis (odds ratio [OR], 2.670; 95%CI, 1.001-7.119), and >1/3 cervical stromal invasion (OR, 3.763; 95%CI, 1.483-9.549). Conclusions: The rates of pathologic high-risk and intermediate-risk factors should be considered and disclosed when counseling patients regarding primary treatment by RHPL. Oncologic outcomes of primary surgical treatment for early-stage cervical carcinoma were found to be excellent.


  1. Attasara P, Sriplung H (2013). Cancer incidence in Thailand. In: Khuhaprema T, Attasara P, Sriplung H, Wiangnon S, Sangrajrang S, eds. Cancer in Thailand Vol. VII. Bangkok: Lyon: International Agency for research on Cancer, 8-76.
  2. Benedet JL, Bender H, Jones H, 3rd, Ngan HY, Pecorelli S (2000). FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet, 70, 209-62.
  3. Cai HB, Chen HZ, Zhou YF, Lie DM, Hou HY (2009). Class II radical hysterectomy in low-risk IB squamous cell carcinoma of cervix: a safe and effective option. Int J Gynecol Cancer, 19, 46-9.
  4. Chatchotikawong U, Ruengkhachorn I, Leelaphatanadit C (2014). Residual disease following conization of women with stage IA-IB1 cervical carcinoma in a high incidence region. Asian Pac J Cancer Prev, 15, 7383-7.
  5. Covens A, Rosen B, Murphy J, et al (2002). How important is removal of the parametrium at surgery for carcinoma of the cervix? Gynecol Oncol, 84, 145-9.
  6. Ditto A, Martinelli F, Bogani G, et al (2015). Implementation of laparoscopic approach for type B radical hysterectomy: a comparison with open surgical operations. Eur J Surg Oncol, 41, 34-9.
  7. Ghezzi F, Cromi A, Ciravolo G, et al (2007). Surgicopathologic outcome of laparoscopic versus open radical hysterectomy. Gynecol Oncol, 106, 502-6.
  8. Henriquez-Hernandez LA, Lloret M, Pinar B, et al (2011). BCL-2, in combination with MVP and IGF-1R expression, improves prediction of clinical outcome in complete response cervical carcinoma patients treated by radiochemotherapy. Gynecol Oncol, 122, 585-9.
  9. Hilton P, Cromwell DA (2012). The risk of vesicovaginal and urethrovaginal fistula after hysterectomy performed in the English National Health Service--a retrospective cohort study examining patterns of care between 2000 and 2008. BJOG, 119, 1447-54.
  10. Landoni F, Maneo A, Colombo A, et al (1997). Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet, 350, 535-40.
  11. Landoni F, Maneo A, Cormio G, et al (2001). Class II versus class III radical hysterectomy in stage IB-IIA cervical cancer: a prospective randomized study. Gynecol Oncol, 80, 3-12.
  12. Lee JM, Lee KB, Lee SK, Park CY (2007). Pattern of lymph node metastasis and the optimal extent of pelvic lymphadenectomy in FIGO stage IB cervical cancer. J Obstet Gynaecol Res, 33, 288-93.
  13. McCann GA, Taege SK, Boutsicaris CE, et al (2013). The impact of close surgical margins after radical hysterectomy for early-stage cervical cancer. Gynecol Oncol, 128, 44-8.
  14. Newton M (1975). Radical hysterectomy or radiotherapy for stage I cervical cancer. A prospective comparison with 5 and 10 years follow-up. Am J Obstet Gynecol, 123, 535-42.
  15. Pecorelli S, Zigliani L, Odicino F (2009). Revised FIGO staging for carcinoma of the cervix. Int J Gynaecol Obstet, 105, 107-8.
  16. Peters WA, 3rd, Liu PY, Barrett RJ, 2nd, et al (2000). 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, 18, 1606-13.
  17. Pikaart DP, Holloway RW, Ahmad S, et al (2007). Clinicalpathologic and morbidity analyses of Types 2 and 3 abdominal radical hysterectomy for cervical cancer. Gynecol Oncol, 107, 205-10.
  18. Rotman M, Sedlis A, Piedmonte MR, et al (2006). A phase III randomized trial of postoperative pelvic irradiation in Stage IB cervical carcinoma with poor prognostic features: followup of a gynecologic oncology group study. Int J Radiat Oncol Biol Phys, 65, 169-76.
  19. Rutledge TL, Kamelle SA, Tillmanns TD, et al (2004). A comparison of stages IB1 and IB2 cervical cancers treated with radical hysterectomy. Is size the real difference? Gynecol Oncol, 95, 70-6.
  20. Ryu SY, Kim MH, Nam BH, et al (2014). Intermediate-risk grouping of cervical cancer patients treated with radical hysterectomy: a Korean gynecologic oncology group study. Br J Cancer, 110, 278-85.
  21. Sedlis A, Bundy BN, Rotman MZ, et al (1999). A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A gynecologic oncology group study. Gynecol Oncol, 73, 177-83.
  22. Siu SS, Cheung TH, Lo KW, Yim SF, Chung TK (2006). Is common iliac lymph node dissection necessary in early stage cervical carcinoma? Gynecol Oncol, 103, 58-61.
  23. Srisomboon J, Kietpeerakool C, Suprasert P, et al (2011). Survival and prognostic factors comparing stage IB 1 versus stage IB 2 cervical cancer treated with primary radical hysterectomy. Asian Pac J Cancer Prev, 12, 1753-6.
  24. Takeda N, Sakuragi N, Takeda M, et al (2002). Multivariate analysis of histopathologic prognostic factors for invasive cervical cancer treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy. Acta Obstet Gynecol Scand, 81, 1144-51.
  25. Vosmik M, Laco J, Sirak I, et al (2014). Prognostic significance of human papillomavirus (HPV) status and expression of selected markers (HER2/neu, EGFR, VEGF, CD34, p63, p53 and Ki67/MIB-1) on outcome after (chemo-) radiotherapy in patients with squamous cell carcinoma of uterine cervix. Pathol Oncol Res, 20, 131-7.