Prognostic factors and impacts of adjuvant therapy in early-stage cervical carcinoma with pelvic node metastases

Three hundred seventy cases of clinical stage Ib-II cervical carcinoma treated with radical abdominal hysterectomy and bilateral pelvic lymphadenectomy at Chang Gung Memorial Hospital between 1981-1986 were reviewed retrospectively. Of these, 105 patients had pelvic lymph node metastases. Clinico-pathological variables including flow cytometric DNA analysis and the use of adjuvant therapy were studied. Recurrence-free survival was significantly worse among patients with positive pelvic nodes by parametrial extension, increasing number of positive nodes, and DNA index greater than 1.3. In patients with positive nodes and negative parametria, the number of positive nodes remained a significant predictor of survival. Utilizing these significant variables, we identified three distinct risk groups. Those patients who had negative parametria, only one positive node, and a DNA index not greater than 1.3 were categorized as the low-risk group. Those who had either positive parametria or more than three positive nodes were categorized as the high-risk group. All the others fell into the intermediate-risk group. Five-year recurrence-free survival rates were 84.6, 71.6, and 42.1%, respectively (P = 0.0006). Applying this risk group classification and the significant risk factors, we may select more appropriate subsets of patients and good stratification for future prospective trials in surgically treated early-stage cervical carcinoma patients with pelvic node metastases.