Prognostic factors and operative treatment of stages IB to IIB cervical cancer.

Between 1971 and 1985, a total of 325 cases of cervical cancer, Stages IB to IIB, in which operation was performed were evaluated with a view toward prognostic factors and survival rates. In radical abdominal operations, a complete resection of parametrial tissue was the goal. Extensive lymphadenectomy of the pelvis was performed. Operative specimens were processed by giant sections comprising cervix, lateral parametria, and vaginal cuff. Lymph nodes were cut by step-serial sections. Exact measurements of tumor sizes were done along with investigations of parametrium and lymph nodes. Tumors were classified according to a ratio of tumor size to size of cervix. Incidence of lymph node involvement increased with tumor size, reaching a maximum of 68.3% in the group with a ratio from 70% to 80%. Direct spread into the parametrium was rarely found, even in larger tumors occupying the entire cervix. parametrial lymph nodes were most often involved; these were scattered over the entire ligament. Five-year survival rates reached 88.1% in patients with no nodal involvement and 60.9% with nodal involvement. In the latter, the results depended on the number of nodal groups involved and the diameter of metastases. Parametrial involvement alone had no influence on healing rates, but when pelvic nodes were simultaneously involved, the results were less satisfactory. Survival rates based on tumor size differed only between the group with a ratio up to 20% and the large-tumor groups, with rates ranging from 97.5% to 70.9%. There was no statistical difference between Stages IB (31.1% positive nodes) and IIB (44.1% positive nodes) with regard to survival rates (82.2% and 76.9%, respectively).