Survival of 231 cervical cancer patients, treated by radical hysterectomy, according to clinical and histopathological features

Purpose of investigation: The purpose of the study was to estimate the five-year survival of cervical cancer patients after radical hysterectomy, taking into account clinical data and histopathological parameters.

Methods: 231 patients with invasive cervical carcinoma were diagnosed, surgically treated--Piver III--and followed-up. Histological examination of specimens was performed according to the British NHS-CSP guidelines.

Results: We discovered no statistical significance as regards age at diagnosis, age at menarche and menopause, and number of pregnancies, deliveries and abortions, in relation to survival. We concluded that the clinical stage according to FIGO classification influenced survival. Statistical significances were: Ia2 vs Ib, Ib vs IIa and IIa vs more advanced than IIa. The following histopathological parameters correlated with survival: depth of cervical invasion, primary lesion volume, and parametrial, uterine, vaginal and lymph node involvement. Using Cox's proportional hazards model we found that only lymph node status and FIGO staging were independent parameters correlating with survival and mortality risk in our study.

Conclusion: Prognostic indexes classifying patients at specific disease stages into different categories of risk should be based on histopathological features listed above. Such indexes are yet to be validated in larger, prospective studies conducted in different patient populations.

Cervical cancer; Clinical staging; Histopathological parameters; Lymph node metastases; Survival prognosis

[1] Kosary C.L.: "FIGO stage, histology, histologic grade, age and race as prognostic factors in determining survival for cancers of the female gynaecological system: an analysis of 1973-1987 SEER cases of cancers of the endometrium, cervix, ovary, vulva, and vagina". Semin. Surg. Oncol., 1994, JO, 31.

[2] Duarte-Franco E., Franco E.L.: "Determinants of patient survival in cervical cancer: an overview". CME J. Gynecol. Oneal., 2001, 6, 173.

[3] Kamura T., Shigematsu T., Kaku T., Shimamoto T., Saito T., Sakai K. et al.: "Histopathological factors influencing pelvic lymph node metastases in two or more sites in patients with cervical carcinoma undergoing radical hysterectomy". Acta Obstet. Gynecol. Scand., 1999, 78, 452.

[4] Baltzer J., Kopcke W.: "Tumor size and lymph node metastases in squamous cell carcinoma of the uterine cervix". Arch. Gynecol., 1979, 227, 271.

[5] Piver M.S., Chung W.S.: "Prognostic significance of cervical lesion size and pelvic node metastases in cervical carcinoma". Obstet. Gynecol., 1975, 46, 507

[6] Brewster W.R., DiSaia P.J., Monk B.J., Ziogas A., Yamada S.D., Anton-Culver H.: "Young age as a prognostic factor in cervical cancer: results of a population-based study". Am. J. Obstet. Gynecol., 1999, 180, 1464.

[7] Schrijvers C.T., Mackenbach J.P.: "Cancer patient survival by socio-economic status in seven countries: a review of six common cancer sites". J. Epidemiol. Community Health., 1994, 48, 441

[8] Sankaranarayanan R., Nair M.K., Jayaprakash P.G., Stanley G., Varghese C., Ramadas V. et al.: "Cervical cancer in Kerala: a hos­pital registry-based study on survival and progno、tic factors". Br. J. Cancer, 1995, 72, 1039.

[9] Hagen B., Skjeldestad F.G., Halvorsen T., Strickert T., Tingulstad S., Lorenz E., Onsrud M.: "Primary treatment of cervical carci­noma. Ten years experience from one Norwegian health region" Acta Obstet. Gynecol. Scand., 2000, 79, 1093.

[10] Lai C.H., Hong J.H., Hsueh S., Ng K.K., Chang T.C., Tseng CJ et al.: "Preoperative prognostic variables and the impact of post­operative adjuvant therapy on the outcomes of Stage 1B or 11 cer­vical carcinoma patients with or without pelvic lymph node metas­tases: an analysis of 891 cases". Cancer, 1999, 85, 1537.

[11] Winter R., Haas J., Reich Lahousen M., Tamussino K.: "Prognos­tic significance of parametrial involvement in cervical cancer". CME J. Gynecol. Oneal., 2001, 6, 204.

[12] Takeda N., Sakuragi N., Takeda M., Okamoto K., Kuwahara M., Neg呴H. et al.: "Multivariate analysis of histopathologic prog­nostic factors for invasive cervical cancer treated with radical hys­terectomy and systematic retroperitoneal lymphadenectomy". Acta Obstet. Gynecol. Scand., 2002, 81, 1144.

[13] Ayhan A., Celik H., Coskun F., Baykal C., Salman M.C., Askan G.: "Restaging in gynaecological cancers". Eur. J. Gynaecol Oneal., 2005, 26, 25.

[14] Burghardt E., Pickel H.: "Local spread and lymph node involve­ment in cervical cancer". Obstet. Gynecol., 1978, 52, I 38.

[15] Shaw M.C., Wolfe C.D., Devaja 0., Raju K.S.: "Development of an evidence-based algorithm for the management of cervical cancer". Eur. J. Gynaecol. Oneal., 2003, 24, 365.