Identifying local tumor variables for operable node-negative, margin-free patients with bulky cervical carcinoma of FIGO stage IB, IIA and IIB without adjuvant therapies

Purpose: To identify local risk factors for FIGO IB, IIA and IIB bulky cervical squamous cell carcinoma (tumor size > or = 4 cm) patients with node-negative, margin-free tumors treated by radical hysterectomy, pelvic lymph node and para-aortic lymph node dissections without adjuvant therapies.

Materials and methods: Thirty-four patients were recruited between 1976 and 1989 because they all declined any postoperative adjuvant therapy. The pathology reports showed that all the specimen margins were free from cancer cells with no para-aortic or pelvic lymph node metastases. The survival interval was calculated starting from the time of surgical intervention to the time of death or the end of this study in the year 2000.

Result: Tumor variables including cell differentiation, depth of stromal invasion, parametrial invasion, vaginal invasion, uterine body invasion, age, and FIGO stage were analyzed. Only vaginal invasion showed statistical significance for decreasing patient disease-free survival in both univariate and multivariate analyses with p values of 0.003 and 0.002, respectively.

Conclusion: For node-negative and margin-free patients with bulky cervical squamous cell carcinoma with operable stage IB and IIB, surgical intervention alone could suffice when no vaginal invasion is noted plus an 85% survival rate could be achieved. A prospective pilot study should be initiated although this study showed an excellent survival rate which is perhaps due to the limited number of cases.

Bulky tumor; Cervical neoplasm; Prognostic factors; Radical hysterectomy

[1] Morrow C.P., Curtin J.P.: "Surgery for cervical ncoplasia". In Morrow C.P.,C urtin J.P. (eds.). Gynecologic Cancer Surgery. New York: ChurchilI-Livingstone,1996, 473.

[2] Rutledge F.N., W harton J.T., Fletcher G.H.: "Clinical studies with adjunctive surgery and irradiation therapy in the treatment of carcinoma of the cervix". Cancer, 1976, 38, 596.

[3] Gallion H.H., van Nagell J.R. Jr., Donaldson E.S. et al.: "Combined radiation therapy and extra-fascia! hysterectomy in the treatment of stage IB barrel-shaped cervical cancer". Cancer, 1985, 56, 262.

[4] Finan M.A., DeCesare S., Fiorica J.Y., Chambers R., Hoffman M.S., Kline R.C. et al.: "Radical hysterectomy for stage IB I vs IB2 carcinoma of the cervix: Does the new staging system predict morbidity and survival?". Gynecol. Oncol., 1996, 62, 139.

[5] Bloss J.D., Berman M.L., Mukhererjee J., Manetta A., Emma D., Ramsanghani N.S., DiSaia P.J.: "Bulky stage IB cervical carcinoma managed by primary radical hysterectomy followed by tailored radiotherapy". Gynecol. Oneal., 1992, 47, 21.

[6] Perez C.A., Breaux S., Askin F., Camel H.M., Powers WE.:''Irradiation alone or in combination with surgery in stage 1B and IIA carcinoma of uterine cervix? A non-randomized comparison'·. Cancer, 1979, 43, 1062.

[7] Delgado G., Bundy B., Zaino R., Sevin B.U., Creasman WT, Major F.: "Prospective surgical-pathological study of disease-free interval in patients with stage 1B squamous cell carcinoma of the cervix". Gynecol. Oneal., 1990, 38, 352.

[8] Sardi J.E., Giaroli A., Sananes C., Ferreira M., Soderini A., Bermudez A et al.: "Long-term follow-up of the first randomized trial using neo-adjuvant chemotherapy in stage IB squamous carcinoma of cervix: the final result". Gynecol. Oneal., 1997, 67, 61.

[9] Keys H.M., Bundy B.N., Stehman FB., Muderspach L.l., Chafe W.E., Suggs C.L. III et al.: "Cisplatin、radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage 1B cervical carcinoma". New Engl. J. Med., 1999, 340, 1154.

[10] Morris M., Eifel P.J., Lu J., Grigby P.W., Levenback C., Stevens R.E. et al.: "Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high risk cervical cancer". New Engl. J. Med., 1999, 340, 1137.

[11] Yuan C.C., Wang P.H., Lai C.R. et al.: "Prognosis-prcdictmg system based on factors related to survival of cervical carcinoma" Int. J. Gynecol. Obstet., 1998, 63, 163.

[12] Yuan C.C., Wang P.H., Lai C.R. et ul.: "Recurrence and survival of I,1 15 cervical cancer patients treated with radical hysterectomy". Gynecol. Obstet. Invest., 1999, 47, 127.

[13] Chao H.T., Wang P.H., Tseng J.Y. et al.: "Lymphocyte infiltrated on FIGO stage IIB squamous cell carcinoma of the cervix is a prominent factor for disease-free survival". Euro. J. Gynecol. Oncol., 1999, 20, 13.

[14] Alvarez R.D., Soong S.J., Kinney W.K. et al.: "Identification of pronogtic factors of radical hysterectomy for early stage squamous carcinoma of the cervix". Gynecol. Oneal., 1989, 35, 130.

[15] Fuller A.F Jr., Elliott N., Kosloff C., Lewis J.L. Jr.: "Lymph node metastases from carcinoma of the cervix, stages Ib and IIa: lmplications for prognosis and treatment". Gynecol. Oncol., 1982, 13, 165.

[16] Fuller AF. Jr., Elliott N., Kosloff C., Hoskins WJ., Lewis J.L. Jr: "Determinants of increased risk for recurrence in patients undergoing radical hysterectomy for stage IB and IIA carcinoma of the cervix". Gynecol. Oneal., 1989, 33, 34.

[17] Kawagoe T., Kashimura M., Matsuura Y., Sugihara K., Toki N.. Aoki T.: "Clinical significance of tumor size in stage 1B and II carcinoma of the uterine cervix". Int. J. Gynecol. Cancer, 1999, 9, 421.

[18] Delgado G., Bundy B.N., Fowler W.C. Jr., Stehman F.B., Sevin B., Creasman W.T. et al.: "A prospective surgical-pathological study of stage I squamous carcinoma of the cervix; a gynecologic pathological study". Gynecol. Oneal., 1989, 35, 314.

[19] Grimard L., Genest P., Girard A., Gerig L., Prefontaine M., Droum P. et al.: "Prognostic significance of endometrial extension in carcinoma of the cervix". Gynecol. Oncol., 1988, 31, 301.

[20] Sedlis A., Bundy B.N., Rotman M.Z., Lentz S.S., Muderspach LL, Zaino RJ.: "A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with staged 1B carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study" Gynecol. Oneal., 1999, 73, 177.

[21] Matsuyama T.,I noue I.,T sukamoto N.,K ashimura M.,K amura T., Saito T., Uchino H.: "Stage IB, IIA, and IIB cervix cancer, post surgical staging, and prognosis". Cancer, 1984, 54, 3072.

[22] Fuller A.F, Molpus K.L.: "Prognostic factors in early rnvasive cervical carcinoma". In: Rubin C.S., Hoskins WJ. (eds.). Cervical Cancer and Preinvasive Neoplasia. New York: Lippincott-Raven, 1996, 223.

[23] Boronow R.C.: " T he bulky 6-cm barrel-shaped lesion of the cervix: primary surgery and postoperative chemoradiation" Gynecol. Oncol., 2000, 78, 313.