A review of prognostic factors in early-stage carcinoma of the cervix (FIGO I B and II A) and implications for treatment strategy

Abstract

Several prognostic factors in stages I B and II A cervical carcinoma have been widely studied to define groups of patients with a poor prognosis. Most of these factors are interrelated. The characteristics which should be regarded as main factors have not yet been defined, because the studies reported were based on mainly retrospective and non-randomized analysis. Reviewing the literature, lymph node metastasis, differentiation grade, tumor size, parametrial extension, lymphblood vessel invasion and cervical invasion seem to be prognostically important factors, which suggests that the subdivision of patients according to the FIG0 classification alone is inaccurate. It seems useful to define subgroups of patients according to tumor characteristics, determined after surgical treatment and accurate histologic examination of the surgical specimen. Patients with one or more of these tumor features need additional treatment to improve survival. The current treatment modalities, such as postoperative radiotherapy, have not been thoroughly evaluated, but doubt exists as to their efficacy. Data in the literature suggest that particularly patients with para-aortic or multiple pelvic lymph node metastasis (> 3) have already developed distant metastases at the time of primary treatment and therefore need adjuvant systemic therapy. Patients with tumors larger than 4 cm in diameter, differentiation grade III, lymph-blood vessel invasion or cervical invasion (of more than 70%) seem to have high recurrence rates at both pelvic and distant sites, indicating that there is also a need for better pelvic control.

Pretreatment prognostic nutritional index is a significant predictor of prognosis in patients with cervical cancer treated with concurrent chemoradiotherapy

“…In cervical cancer, stage, tumor size, histological type, presence of lymphovascular invasion and metastasis to the regional LNs at the time of diagnosis are significant prognostic factors (3,4). However, the prognostic value of SIR in cervical cancer remains unknown.…”

“…Poor prognostic factors for cervical cancer include stage, tumor size, histology and lymph node (LN) metastasis (3,4). However, these parameters are not sufficient to accurately predict prognosis.…”

Low podoplanin expression in pretreatment biopsy material predicts poor prognosis in advanced-stage squamous cell carcinoma of the uterine cervix treated by primary radiation

“…[4][5][6] Many patients with advanced-stage disease are treated primarily with nonsurgical methods after biopsy confirmation of the diagnosis. However, the presence of lymphatic invasion might be underestimated in biopsy material due to the size of tumor sampling.…”

“…3 Indeed, lymphatic invasion and nodal metastasis have been found to be predictors of shorter diseasefree and overall survival in carcinoma of the uterine cervix. [4][5][6] Patients with locally advanced disease (stages IIB-IV), however, are treated primarily with radiation and radiosensitizing chemotherapy to the primary tumor and the pelvic lymph nodes after biopsy confirmation of the diagnosis. Although this approach can control disease in the pelvis, microscopic spread to areas outside of the pelvis, such as the para-aortic nodes, are not included in pelvic radiation fields.…”

Pretreatment Factors Associated with Recurrence for Patients with Cervical Cancer International Federation of Gynecology and Obstetrics Stage IB1 Disease

“…These include regional lymph node metastasis, parametrium involvement, positive surgical margin, lymphovascular space involvement, deep stromal invasion, and large tumor size [3,4,5]. However, these pathological factors cannot be used to define the prognosis prior to treatment or for patients who have not received surgery.…”