Prognostic significance of parametrial extension in patients with cervical carcinoma Stages IB, IIA, and IIB. A study of 628 cases treated by radical hysterectomy and lymphadenectomy with or without postoperative irradiation.

Parametrial extension was evaluated as a prognostic factor in 628 patients with cervical carcinoma treated by radical hysterectomy and pelvic lymphadenectomy at the Aichi Cancer Center in Nagoya, Japan. Clinical examination without anesthesia staged 362 cases as IB, 43 as IIA, and 223 as IIB. Parametrial extension was found in 25 (7%) with Stage IB, 10 (23%) with IIA, and 76 (34%) with IIB. Nodal metastasis was shown in 47 (13%) with Stage IB, 10 (23%) with IIA, and 86 (39%) with IIB. When cancer extended into the parametrial tissues, nodal (N) metastasis rates were significantly increased from 12% to 32% for Stage IB (P less than 0.005), from 9% to 70% for IIA (P less than 0.001), and from 29% to 58% for IIB (P less than 0.001). Incidence of patients with one to three positive nodes decreased, and that of those with four or more positive nodes increased with parametrial extension (P less than 0.01). Corrected 5-year survival rates of patients were 94% for Stage IB, 95% for IIA, and 78% for IIB. Although there were differences between survivals of patients with Stage IB [N(-)] and IIB N(-) (P less than 0.05), as well as between those with IB [N(+)] and IIB N(+) (0.05 less than P less than 0.1), these differences disappeared when the cases were subdivided by parametrial extension. These results indicate that parametrial extension is a very important factor in nodal metastasis, number of positive nodes, and patient survival.