OBJECTIVE: Patients with TNM T1a cervical cancer have excellent prognosis; however, the risk for recurrence remains an issue of concern and management guidelines are based on limited data. Here we performed subgroup analysis of the Surveillance in Cervical Cancer (SCCAN) consortium with the objective of defining the prognosis of T1a cervical cancer patients. METHODS: SCCAN was an international, multicentric, retrospective cohort study of patients with cervical cancer undergoing surgical treatment in tertiary centers. Inclusion criteria included: histologically confirmed cervical cancer treated between 2007 and 2016; TNM T1a; primary surgical management; and at least 1-year of follow-up data availability. Exclusion criteria included treatment with primary chemo-radiation, and missing treatment-related or clinical data. RESULTS: Out of 975 patients included, 554 (57 %) were T1a1 and 421 (43 %) T1a2. The majority had squamous-cell carcinoma (78 %). 79 patients (8.1 %) had lymphovascular space invasion (LVSI). 455 patients (47 %) underwent radical hysterectomy/ parametrectomy. Laparoscopic and open surgery was performed in 401 (41 %) and in 361 (37 %) patients, respectively. Adjuvant treatment was administered to 56 patients (5.7 %). Assessment of lymph nodes (LN) was performed in 524 patients (54 %), with LN involvement found in 15 (2.9 %). There were 40 (4.1 %) recurrences, occurring at a median of 26 months (4-106), out of which 33 (82.5 %) occurred in pelvis. Among T1a1 cases, there were 10 recurrences (2.0 %) if LVSI was negative, and 3 recurrences (6.7 %) if LVSI was positive. Among T1a2 cases, there were 23 recurrences (6.7 %) if LVSI was negative, and 4 recurrences (5.1 %) if LVSI was positive. There were 3 recurrences in the LN+ group (recurrence rate 20 %). CONCLUSIONS: The risk of recurrence in T1a cervical cancer was 4.1 % corresponding to the rates seen in patients with FIGO 1B cancer in recently published prospective trials. LN involvement represents a risk factor for disease recurrence. Our results indicate that stage T1a cervical cancer, apart from T1a1 LVSI negative disease, should follow the same principles in the management as that of FIGO stage 1B cancer.

Amsterdam Medical Center Amsterdam the Netherlands

Department of Gynaecological Oncology KK Women's and Children's Hospital Singapore

Department of Gynecologic Oncology Instituto Nacional de Cancerología in Bogotá Colombia

Department of Gynecological Surgery National Institute of Neoplastic Diseases Lima Peru

Department of Obstetrics and Gynecology Faculty of Medicine University Hospital and University of Ostrava Ostrava Czech Republic

Department of Obstetrics and Gynecology Houston Methodist Hospital Houston TX USA

Department of Pathology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Pelvic Cancer Karolinska University Hospital and Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden

Fondazione Policlinico Universitario A Gemelli IRCCS UOC Ginecologia Oncologica Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica Rome Italy

Gynecologic Oncology Center Department of Obstetrics and Gynecology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Gynecology Medical University of Graz Graz Austria

Gynecology Oncology Center National Institute of Cancerology Mexico Mexico

Memorial Sloan Kettering Cancer Center USA

Queensland Centre for Gynaecological Cancer The University of Queensland Brisbane Australia

University Hospital Brno Medical Faculty of Masaryk University Czech Republic

University of Milano Bicocca Department of Obstetrics and Gynecology Gynaecologic Oncology Surgical Unit ASST Monza San Gerardo Hospital Monza Italy

Wolfson Institute of Preventive Medicine Barts Cancer Centre Queen Mary University of London and Barts Health NHS Trust London UK

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