A Retrospective Study of Clinicopathological Features and Survival Outcomes in 305 Surgically Treated Patients with Stage IB-IIA Cervical Squamous Cell Carcinoma

To investigate the clinicopathological characteristics and survival outcomes of 305 surgically treated patients with stage IB-IIA cervical squamous cell carcinoma (CSCC).

Clinical data of 305 CSCC patients treated at our hospital from March 2015 to December 2019 were retrospectively analyzed. Clinicopathological features were summarized, prognostic factors identified, and survival outcomes assessed using Kaplan-Meier and Cox regression analyses.

The most common symptoms were irregular bleeding (49.8%) and contact vaginal bleeding (35.7%). Tumors <4 cm accounted for 75.1%, and International Federation of Gynecology and Obstetrics (FIGO) stage IIA was more frequent than stage IB (52.8% vs 47.2%). Deep stromal invasion (≥1/2) and lymph node metastasis were observed in 75.7% and 19.3% of patients, respectively. Ovarian preservation occurred in 12.8% of cases. Postoperative adjuvant therapy was given in 79.3% of patients, with 41.3% receiving concurrent chemoradiotherapy. Lower apparent diffusion coefficient (ADC) values were significantly associated with higher FIGO stage, deeper invasion, lymph node metastasis, and more intensive adjuvant therapy (P<0.05). The 3-year overall survival (OS) and disease-free survival (DFS) rates were 88.5% and 84.6%, respectively. Cox analysis identified FIGO stage, lymph node metastasis, depth of invasion, and adjuvant therapy as independent prognostic factors (P<0.05). Kaplan-Meier analysis showed significantly lower OS in patients with FIGO stage IIA, deep invasion, lymph node metastasis, and no or single-modality adjuvant therapy.

The pathological features of patients with CSCC are closely associated with ADC values derived from diffusion-weighted imaging (DWI). Vaginal bleeding, depth of invasion, FIGO stage, postoperative treatment, and lymph node metastasis are key prognostic factors. Patients with stage IIa, lymph node metastasis, no adjuvant therapy, or invasion depth ≥1/2 have a poorer prognosis.