Treatment and outcome of Stage I A1 squamous carcinoma of the cervix: a clinicopathologic study of 346 cases

Objective: To analyze the clinicopathologic feature of Stage I A1 squamous carcinoma of the cervix (SCC) and to explore the outcome of different surgical methods. Materials and Methods: Clinicopathological data of 346 cases with Stage I A1 SCC diagnosed between November 2^nd, 1995 and December 31^st, 2011 were reviewed and analyzed. Results: As major diagnostic method, 44.5% (154/346) patients accepted cold knife conization (CKC), while 58.1% (201/346) patient took total hysterectomy (TH) as their final surgical methods. The trend in treatment methods from 1995 to 2011 revealed that increasing cases were treated with CKC, modified radical hysterectomy (MRH) obviously reduced, while the proportion treated by TH remained unchanged. Due to a small number of cases receiving vaginal trachelectomy (VT) and radical trachelectomy (RT), the authors did not find any obvious changes. Prognosis: The overall recurrence rate was 1.2% (4/346). The overall survival rates for CKC, VT, TH, MRH, and RT were 100%, 100%, 98.2%, 100%, and 100%, and the difference was not statistically significant (p = 0.819). The incidence rate of LVSI was 4.9% (17/346), the overall survival rates for patients with LVSI and without LVSI were 99.3% and 93.3%, respectively, and there was statistical difference between them (p = 0.003). Univariate analysis showed that only LVSI was an important predictor for survival (p = 0.030). Conclusions: the treatments for Stage I A1 SCC are becoming more conservative, and individualized therapy and more frequent surveillance should be administrated to those patients with LVSI.

Microinvasive carcinoma of the cervix; Surgical treatment; Prognosis; Lymphovascular space invasion.

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