Prognostic factors of early stage cervical cancer treated by radical hysterectomy

Abstract

Background. This study was performed to identify pathologic and clinical features that best correlate with lymph node metastasis and disease free survival among patients with Stage I and II cervical cancer treated by radical hysterectomy. Methods. Three hundred‐seventy patients with complete clinical information and pathologic material, including cone and cervical biopsies, were selected for analysis. Of these patients, 301 with clinical stages I and II disease were the subject of this paper. The results of patients with microinvasive carcinoma of the cervix, as defined by the Society of Gynecologic Oncologists (depth of invasion $3 mm and no lymph node vascular space invasion), were reported previously1 and excluded from this analysis. Patients with small cell carcinoma of the cervix were found to have a very poor prognosis (disease free 5‐year survival of 36%) and were also excluded from this analysis (Sevin BU, Nadji M, Metkoch MW, Lu Y, Averette HE. Unpublished data, 1995). Variables studied were patient age, weight, race, marital status, and economic status; tumor size; depth of invasion; lymph node–vascular space involvement; cell type; tumor grade; lymph node metastasis; and number of lymph nodes removed. The influence of these variables on survival was examined by univariate analysis with use of Cox's regression model and the log rank test for comparison of survival curves. Results. Factors that predict disease free survival, ranked by degree of significance, were depth of invasion, tumor size, lymph node–vascular space invasion, number of positive nodes, tumor volume, clinical stage, and tumor extension to the vagina or surgical margins. Conclusions. Radical hysterectomy and bilateral lymphadenectomy is standard therapy for patients with Stage IB and IIA carcinoma of the cervix. A variety of surgically defined risk factors predict 5‐year disease free survival, and many of these factors are related. Identification of independent risk factors requires a multivariate analysis of data. Cancer 1995; 76:1978–86.

Occult parametrial metastasis in operable cancer cervix: is a routine radical hysterectomy justified?

“…12 Sevin et al also found significantly lower rates of PLM in stages I and II of cervical cancers when the PTD was less than 2 cm and the rates doubled when it reached 3 cm. 13 The findings of our study is also in agreement with all these findings and PLM and PTD have been found to be the most significant risk factors for OPM. However, these criteria are based on the final histopathology and hence cannot be preoperatively assessed (except for PTD) thus making prediction of OPM risk impossible.…”

Involvement of the TGF-β and β-Catenin Pathways in Pelvic Lymph Node Metastasis in Early-Stage Cervical Cancer

“…Several histopathological characteristics such as tumor size, lymph vascular space involvement, and depth of invasion have been associated with lymph node metastases in cervical cancer but none of these is of sufficient clinical relevance (4). Furthermore, various molecular tumor markers like the expression of VEGF and p16 have been reported to be related with lymph node metastases in cervical cancer (5,6), but presently no markers are available to predict lymph node status with high sensitivity and specificity.…”

The epidermal growth factor receptor pathway in relation to pelvic lymph node metastasis and survival in early-stage cervical cancer

“…In cases with poor clinicopathologic factors, adjuvant radiotherapy with or without chemotherapy is often administered. Conventional prognostic factors in early-stage cervical cancer are tumor size, depth of stromal invasion, lymphovascular space involvement, parametrial invasion, and pelvic lymph node metastasis [1][2][3][4]. Pelvic lymph node metastasis appears to be the most important of these parameters [5], with a 5-year survival approximating 90% in node-negative early-stage cervical cancer patients primarily treated with surgery and decreasing to approximately 65% in patients with pelvic lymph node metastasis [6].…”