Locoregional Spread and Survival of Stage IIA1 versus Stage IIA2 Cervical Cancer


This study was undertaken to compare surgical outcomes and survival rates of patients with the 2009International Federation of Gynecology and Obstetrics (FIGO) stage IIA1 versus IIA2 cervical cancer treatedwith radical hysterectomy and pelvic lymphadenectomy (RHPL). Patients with stage IIA cervical cancerundergoing primary RHPL between January 2003 and December 2012 at Chiang Mai University Hospital wereretrospectively reviewed. The analysis included clinicopathologic variables, i.e. nodal metastasis, parametrialinvolvement, positive surgical margins, deep stromal invasion (DSI)), lymph-vascular space invasion (LVSI),adjuvant treatment, and 5-year survival. The chi square test, Kaplan-Meier method and log-rank test were usedfor statistical analysis. During the study period, 133 women with stage IIA cervical cancer, 101 (75.9 %) stageIIA1, and 32 (24.1 %) stage IIA2 underwent RHPL. The clinicopathologic variables of stage IIA1 comparedwith stage IIA2 were as follows: nodal metastasis (38.6% vs 40.6%, p=0.84), parametrial involvement (10.9% vs15.6%, p=0.47), positive surgical margins (31.7% vs 31.3%, p=1.0), DSI (39.6% vs 53.1%, p=0.18), LVSI (52.5%vs 71.9%, p=0.05) and adjuvant radiation (72.3% vs 84.4%, p=0.33). With a median follow-up of 60 months,the 5-year disease-free survival (84.6% vs 88.7%, p=0.67) and the 5-year overall survival (83.4% vs 90.0%,P=0.49) did not significantly differ between stage IIA1 and stage IIA2 cervical cancer. In conclusion, patientswith stage IIA1 and stage IIA2 cervical cancer have comparable rates of locoregional spread and survival. Theneed for receiving adjuvant radiation was very high in both substages. The revised 2009 FIGO system did notdemonstrate significant survival differences in stage IIA cervical cancer treated with radical hysterectomy.Concurrent chemoradiation should be considered a more suitable treatment for patients with stage IIA cervicalcancer.