Objective To investigate the tumor-free survival time and prognostic factors of patients with stage I_b surgical treatment of cervical squamous carcinoma. Methods We retrospectively analyzed the data of 206 patients with stage I_b cervical squamous carcinoma who underwent Piverm III radical cervical cancer surgery + pelvic lymph node dissection in our hospital before 2006 and 7 years ago. Among them, 103 were stage I_(B1) and 103 were stage I_(B2); 79 were treated with preoperative radiotherapy and 111 were treated with postoperative adjuvant therapy. Survival rate was calculated by Kaplan-Meier method with Logrank test and univariate prognostic analysis, and Cox model was used for prognostic multifactor analysis. The follow-up rate was 92.7%, and 106 cases were followed up for 5 years. The 5-year tumor-free survival rate and overall survival rate of the whole group were 86.8% and 96.3%, respectively, and the stage I_(B1) and I_(B2) were 94.6% and 100%, 77.9% and 92.2%, respectively. Univariate analysis showed that tumor size/b (FIGO stage), vascular tumor embolus, vaginal involvement below the fornix, positive parametrium and number of lymph node metastases >2 had an effect on 5-year tumor-free survival in stage I_b, 77.9%:94.6% (χ~2=5.58, P=0.018), 74.6%:89.8% (χ~2=10.44, P=0.001), respectively. 50%:87.9% (χ~2=7.01,P=0.008), 63.5%:89.5% (χ~2=17.69,P=0.000) and 43.6%:89.4% (χ~2=21.47,P=0.000). Multifactorial analysis showed that HGO stage, vascular tumor embolism, and number of lymph node metastases >2 had an effect on 5-year tumor-free survival in the whole group (χ~2=4.73, P=0.030; χ~2=9.81, P=0.002; χ~2=6.30, P=0.012); vascular tumor embolism and number of lymph node metastases >2 had an effect on 5-year tumor-free survival in stage I_(B2) (χ~2= 6.38, P=0.012; χ~2=3.92, P=0.048). Conclusion In squamous carcinoma of the cervix, choroidal aneurysm embolus is an important predictor of tumor-free survival in stage I_(B1). Postoperative radiotherapy reduced stage I_(B2) recurrence but did not improve overall survival. If postoperative adjuvant radiotherapy is necessary for stage I_(B2), preoperative radiotherapy is only used to improve the success rate of surgery, but has no effect on tumor-free survival. If only deep muscle infiltration is present in stage I_(B1), postoperative adjuvant radiotherapy should be reduced.