Lymphovascular and perineural invasion in the parametria: a prognostic factor for XXXX .

@entity1 @entity66 @entity5 @entity957 @entity3 @entity420
OBJECTIVE: To estimate the impact of parametrial lymphovascular and perineural involvement on nodal @entity3 and failure pattern of @entity1 with early-stage, surgically treated @entity5 . METHODS: Clinical records and pathologic slides of 93 @entity1 with @entity5 (2 IA2, 52 IB1, 31 IB2, and 8 IIA) treated with radical hysterectomy and pelvic lymphadenectomy with or without paraaortic lymphadenectomy were reviewed. The study group comprised 80 @entity1 with @entity957 and 13 @entity1 with @entity420 . Median follow-up time was 33 months. The association among the various histopathologic predictors of outcome was determined with chi2 analysis. The influence of the predictors on outcome was examined with log rank survival methods and the Cox regression model. RESULTS: The presence of parametrial lymphovascular space invasion is a predictor of disease in the pelvic (P<.001) and paraaortic (P<.05) lymphatics independently. Large @entity5 size (greater than 4 cm), parametrial perineural invasion, cervical lymphovascular space invasion, and @entity5 depth (greater than two thirds) were found to be simultaneous predictors of recurrence on multivariate analysis (P<.05). Using these four binary predictor variables, we have computed a model-based relative risk. Based on this model, the presence of perineural invasion in the parametria more than doubles the risk of recurrence in the cohort of @entity1 with large (greater than 4 cm) @entity5 (P<.05). In a subset analysis of @entity1 with negative @entity66 , parametrial perineural invasion and @entity5 size were independent predictors of poor outcome (P<.05). CONCLUSION: Presence of parametrial lymphovascular space invasion correlates significantly with the risk of nodal @entity3 in @entity1 with @entity5 . Parametrial perineural invasion is an independent poor prognostic factor. Histopathologic findings within the parametria are a valuable independent predictor of recurrence and thus may influence the selection of @entity1 for adjuvant treatment.
