The purpose of the present study was to identify a subset of high-risk patients among surgically treated node-positive patients with stage IB and IIA cervical carcinoma. From 1982 through 1991, 334 patients underwent radical hysterectomy for FIGO stage IB and IIA cervical carcinoma. In 68 patients pathological analysis of the surgical specimen revealed positive pelvic nodes. In this group, a Cox proportional hazard analysis was performed to examine the prognostic significance of clinicopathological variables. Only for adenocarcinoma (P = 0.002) and parametrium infiltration (P = 0.003) was evidence of an association with prognosis found. Based on these two factors, patients with positive pelvic nodes were categorized into a low-risk group (squamous cell carcinoma without parametrium infiltration, N = 33) and a high-risk group (squamous cell carcinoma with parametrium infiltration or adenocarcinoma, N = 34). The 5-year disease-specific survival in the low-risk group was 94% compared with 60% in the high-risk group (P = 0.003). For patients in the high-risk group, there is an urgent need for alternative adjuvant treatment to improve outcome.
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