Prognostic factors in advanced stage squamous cell cancer of the cervix

Abstract

Background. This study was undertaken to review prognostic factors for advanced squamous cell cancer of the cervix. Methods. A clinicopathologic review of patients diagnosed with advanced stage squamous cell cancer of the cervix was performed at the University of Michigan Medical Center, Ann Arbor, Michigan, from 1970–1985. Results. All patients had squamous cell disease and were divided according to the following stages: Stage IIIa (4), Stage IIIb (113), Stage IVa (32), and Stage IVb (26). The cumulative 5‐year survival was as follows: Stage IIIa (50%), Stage IIIb (37%), Stage IVa (14%), and Stage IVb (4%). Prognostic features for Stage IIIb disease showed that the intravenous pyelogram status significantly predicted cumulative 5‐year survival (P = 0.00001). When the intravenous pyelogram was normal, 47% survived. When ureteral obstruction was present without renal failure, 29% survived, and when renal failure occurred, all patients were dead of disease by 16 months. The lymph node status significantly influenced cumulative 5‐year survival (P = 0.004). When lymph nodes were negative, 47% survived. When three or fewer were positive, 44% survived. When more than three were positive, 11% survived. When pelvic lymph nodes were positive and paraaortic node status was determined, 25% survived when paraaortic lymph nodes were negative, while 8% survived when these were positive (P = 0.06). Factors that did not influence 5‐year survival included one or both sidewall involvement (P = 0.77), tumor grade (P = 0.23), diabetes (P = 0.92), hypertension (P = 0.85), and obesity (P = 0.47). The diagnosis of Stage IVa disease was made by the presence of fistula at initial presentation (n = 8), cystoscopy (n = 21), and sigmoidoscopy (n = 1). One patient developed a treatment‐related vesicovaginal fistula when bladder involvement was diagnosed by cystoscopy. Ah 18 patients who presented with renal failure (Stage IIIb, 9; Stage IVa, 9) were analyzed as a group, and only 1 patient survived. The median survival in 15 patients who underwent nephrostomy was 8 months, range 1–36 months. Ten of 15 patients (66%) were dead of disease within 1 year. Three patients refused renal bypass, and these three patients died at 1,2, and 3 months, respectively. Conclusions. Advanced stage disease represents a significant challenge, and when ureteral obstruction or renal failure is present, the prognosis is markedly decreased.

Management of patients with carcinoma of the cervix with anuric renal failure

“…Our results are similar to those of Hopkins and Moreley [1] and Fallon et al [2]. When renal failure occurred, all patients were dead of disease by 16 months [1].…”

“…When renal failure occurred, all patients were dead of disease by 16 months [1]. Abnormal IVP was a risk factor that decreased survival rate to 20% of that of patients with normal IVP [2].…”

The Impact of Obesity on the Incidence and Treatment of Gynecologic Cancers: A Review

“…Because the data linking obesity to increased cervical cancer is limited, it seems more likely that the excess mortality could be either the result of a lack of screening in obese women or a detrimental impact of obesity on treatment outcomes. In contrast to the large population studies just mentioned, several smaller retrospective studies have not shown obesity to be a factor that negatively influences survival in women with cervical cancer (94,95).…”

The effects of body mass index on complications and survival outcomes in patients with cervical carcinoma undergoing curative chemoradiation therapy

“…(14, 15) A more recent larger retrospective study of 738 cervical cancer patients demonstrated that a higher BMI was associated with a more favorable outcome. (16) The authors did not report any adverse influence of BMI on outcomes.…”