Lymph node metastasis as a prognostic factor in cervical carcinoma

MATERIAL AND METHODS: 499 patients with cervical carcinoma at stage I and IIa after radical hysterectomy were included in the study. Diagnosis was based on gynecological examinations and cervical biopsies. Clinical staging was determined by FIGO classification. Pelvic lymph nodes were routinely removed on hysterectomy. RESULTS: Metastatic nodes were observed in 26.3% (131 patients). We found no metastatic nodes at stage Ia. In the group of 410 patients with stage Ib cervical cancer metastases in lymph nodes were found in 24.6% (101 patients). In the group of 78 patients with stage IIa cervical cancer metastatic nodes were observed in 38.5% (30 patients). In our finding metastases were located in one group of lymph nodes in 64.4% (64 patients) with stage Ib and 43.3% (13 patients) with stage IIa. Metastatic involvement of more than one group of lymph nodes was observed in 36.6% (37 patients) of stage Ib and 56.7% (17 patients) of stage IIa. The most frequent pattern of lymph nodes metastatic involvement comprised common iliac and obturatorious nodes. 5 year survival in the group without metastases in lymph nodes was estimated at 82.2%, and in the group with nodal metastases--50.8% (p = 0.005). CONCLUSIONS: 1. Metastases to pelvic lymph nodes are significant prognostic factor of long-term survival in patients with cervical cancer. 2. Patients with metastases in lymph nodes and no subsequent postoperative radiotherapy had significantly worse long-term survival.     

子宫颈鳞癌Ⅰb～Ⅱa期患者预后预测系统的建立及其临床意义

目的分析子宫颈鳞癌Ⅰb~Ⅱa期患者的预后影响因素并建立预后预测系统,以探讨其在指导术后辅助治疗中的作用。方法回顾性分析接受手术治疗的306例Ⅰb~Ⅱa期宫颈鳞癌患者的临床病理资料,对影响其预后的因素进行单因素和多因素分析。结果306例患者的5年生存率为78 1%。单因素分析结果显示,与其预后有关的因素为淋巴结转移、病理分化程度、肿瘤直径、宫旁组织浸润、深肌层浸润和脉管内瘤栓(P<0 05);多因素分析结果显示,淋巴结转移、深肌层浸润、宫旁组织浸润是影响其预后的独立危险因素(P<0 05)。根据危险因素的不同建立预后预测系统,即将患者分为低危组、中危组和高危组3组,其5年生存率分别为90 3%、83 9%和43 1%。低危组(无危险因素或仅宫旁组织浸润)局部复发的发生率仅为2 2%;中危组(深肌层浸润或合并有宫旁组织浸润)局部复发的发生率为13 5%,远处转移的发生率为1 3%, 局部复发合并远处转移的发生率为0 6%;高危组(淋巴结转移或合并其他危险因素)局部复发和远处转移的发生率分别为25 9%和48 3%,局部复发合并远处转移的发生率为10 3%。结论淋巴结转移、深肌层浸润、宫旁组织浸润是影响Ⅰb~Ⅱa期宫颈鳞癌患者预后的独立因素;根据预后影响因素建立的预后预测系统有助于指导术后辅助治疗。     

Multivariate analysis of histopathologic prognostic factors for invasive cervical cancer treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy

BACKGROUND: The aim of this study was to identify the independent histopathologic prognostic factors for patients with cervical carcinoma treated with radical hysterectomy including paraaortic lymphadenectomy. METHODS: A total of 187 patients with stage IB to IIB cervical carcinomas treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy were retrospectively analyzed. The median follow-up period was 83 months. Cox regression analysis was used to select independent prognostic factors. RESULTS: Using multivariate Cox regression analysis, lymph node (LN) status (negative vs. metastasis to pelvic nodes except for common iliac nodes vs. common iliac/paraaortic node metastasis), histopathologic parametrial invasion, lymph-vascular space invasion (LVSI), and histology of pure adenocarcinoma were found to be independently related to patients' poor survival. For patients who had a tumor histologically confined to the uterus and have neither parametrial invasion nor lymph node metastasis, LVSI was the most important prognostic factor, and histologic type, depth of cervical stromal invasion, and tumor size were not related to survival. The survival of patients with a tumor extending to parametrium or pelvic lymph node(s) was adversely affected by histology of pure adenocarcinoma. When the tumor extended to common iliac or paraaortic nodes, patients' survival became quite poor irrespective of LVSI or histologic type of pure adenocarcinoma. Patients' prognosis could be stratified into low risk (patients with a tumor confined to the uterus not associated with LVSI: n = 80), intermediate risk (patients with a tumor confined to the uterus associated with positive LVSI, and patients with squamous/adenosquamous carcinoma associated with pelvic lymph node metastasis or parametrial invasion: n = 86), and high risk (patients with pure adenocarcinoma associated with pelvic lymph node metastasis or parametrial invasion, and patients with common iliac/paraaortic node metastasis: n = 21) with an estimated 5-year survival rate of 100 +/- 0 (mean +/- SE)%, 85.5 +/- 3.9%, and 25.1 +/- 9.7%, respectively. CONCLUSIONS: LN status, parametrial invasion, LVSI, and histology of pure adenocarcinoma are important histopathologic prognostic factors of cervical carcinoma treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy. Prognosis for patients with cervical carcinoma may be stratified by combined analysis of these histopathologic prognostic factors. Postoperative therapy needs to be individualized according to these prognostic factors and validated for its efficacy using randomized clinical trials.     

Prognostic factors in surgically treated stage ib-iib cervical carcinomas with special emphasis on the importance of tumor volume.

OBJECTIVE: The aim of the study was to analyze the importance of tumor volume as a prognostic factor for overall survival (OS) in surgically treated stage Ib-IIb cervical carcinoma. METHODS: One hundred thirteen of one hundred sixty-five patients with histopathological stage Ib-IIb cervical carcinoma (44 Ib1, 24 Ib2, 10 IIa, 35 IIb) treated by radical abdominal hysterectomy between 1989 and 1999, for whom tumor volume could be assessed, were included in this study. Of the 113 patients, 90 (79.6%) received postoperative radiotherapy. Measurement of tumor volume was performed on giant histological sections using a semiautomatic image analyzer. The prognostic significance of tumor volume was analyzed and compared with that of various clinicopathological parameters using uni- and multivariate statistics. RESULTS: The 5-year disease-free survival was 71.4%. Increasing tumor volume was associated with more frequent lymph node metastases and a significant decrease in OS (P = 0.0112). The Median tumor volume was smaller in stage IIa tumors than in stage Ib2 tumors, and histopathological stage did not correlate linearly with lymph node metastases as well as OS. Stage Ib2 tumors were associated with worse overall survival than stage IIa tumors. In univariate analysis, lymph node metastases, histopathological stage, lymph vascular space involvement, tumor volume, parametrial spread, and tumor involvement of resection margins were significant parameters for OS. In multivariate statistical analysis, only lymph node metastases and histopathological staging remained independent prognostic factors for OS. CONCLUSIONS: Tumor volume does not seem to confer additional prognostic information if histopathological stage and lymph node status are known. However, it may provide important prognostic information if lymph node status is not known or histopathological stage cannot be assessed.     

Value of preoperative serum CA125 in early-stage adenocarcinoma of the uterine cervix without pelvic lymph node metastasis

OBJECTIVE: This investigation attempted to clarify the value of preoperative serum CA125 in predicting histopathological prognostic factors for early-stage cervical adenocarcinoma without lymph node metastasis. METHODS: This study initially surveyed 163 patients with clinical stage Ib or IIa cervical adenocarcinoma treated with radical hysterectomy and pelvic lymphadenectomy. Of the 163 patients, 116 had preoperative serum CA125 levels, and 14 had pelvic lymph node metastasis. The investigation group comprised 102 lymph node-negative patients. RESULTS: A cutoff value of 26 U/ml was obtained after the discriminant function analysis for identifying patients with positive lymph vascular space invasion (LVSI) or depth of stromal invasion > or =2/3 thickness. Multivariate analysis revealed that among the preoperative clinicopathological variables, including age, tumor size, parametrial invasion, and CA125 level, raised CA125 most significantly influenced the assessment of the LVSI (P = 0.040) and depth of cervical stromal invasion (P = 0.002). CONCLUSIONS: In early-stage cervical adenocarcinoma with negative pelvic lymph node metastasis, preoperative serum CA125 levels at the cutoff value of 26 U/ml impacted the determination of the poor histopathological prognostic factors.     

Radical hysterectomy in cervical carcinoma stage Ib

We present a retrospective analysis of the results of radical hysterectomy in 115 patients with Stage Ib cervical carcinoma. The recurrence frequency was 10% and the 5-year survival rate was 95%. The prognosis correlated with the presence of lymph node metastases which were found in 14%. The 5-year survival rate was 98% in patients without lymph node involvement and 78% in patients with pelvic lymph node metastases. The operative mortality was zero and the frequency of complications was low. Sixty-nine per cent of the patients had returned to work three months after the operation. Radical hysterectomy of stage Ib patients is recommended as the treatment of choice provided a proper preoperative selection is performed.     

Stromal invasion of the cervix can be excluded from the criteria for using adjuvant radiotherapy following radical surgery for patients with cervical cancer

BACKGROUND: Regarding complications of radiotherapy, the indications for adjuvant radiotherapy should be restricted. We conducted the present study to determine whether deep stromal invasion of the cervix could be excluded from the criteria used to identify patients for this treatment surgery. METHODS: This study included 115 patients with FIGO stage Ib to IIb cervical cancer who underwent radical hysterectomy and pelvic lymph node dissection. Patients had the following tumors: 61 nonkeratinizing squamous cell carcinoma, 21 keratinizing squamous cell carcinoma, 26 adenocarcinoma, and 7 adenosquamous cell carcinoma. Our study criteria for using adjuvant radiotherapy included positive lymph node involvement, a compromised surgical margin, or parametrial extension. Deep stromal invasion of the cervix was excluded from the criteria in this study. RESULTS: Seventy-two of the 115 patients (62.6%) underwent radical surgery only and all were alive. The remaining 43 patients received a complete course of external irradiation following radical surgery. The estimated 5-year survival rate is 100% for patients with stage Ib, 93.3% for stage IIa, and 52.7% for stage IIb. Fifty-five patients (47.8%) had deep stromal invasion. The prognosis for patients with deep stromal invasion was significantly worse than that for patients without deep stromal invasion (5-year survival rate, 69.8% vs. 98.0%). However, 21 patients (18.3%) with deep stromal invasion, but without positive lymph node involvement, compromised surgical margin, or parametrial extension, were alive without recurrence. Multivariate analysis showed that lymph node involvement and parametrial extension were independent prognostic factors, but that deep stromal invasion was not. CONCLUSION: Deep stromal invasion of the cervix can be excluded from the list of criteria for selecting patients with cervical cancer who would benefit from adjuvant radiotherapy following radical surgery.     

A comparison of prognoses of pathologic stage Ib adenocarcinoma and squamous cell carcinoma of the uterine cervix

OBJECTIVES: The influence of the histology of adenocarcinoma on recurrence and survival for patients treated with radical hysterectomy and diagnosed as having pathologic stage Ib cervical cancer was investigated. METHODS: Five hundred and nine patients (405 squamous cell carcinomas, 104 adenocarcinomas) with pathologic stage Ib cervical cancer treated initially at the Aichi Cancer Center between 1976 and 1995 were studied. RESULTS: Multivariate analysis identified the prognostic variables as histology of adenocarcinoma, number of lymph nodes involved, and tumor size beyond 4 cm. Five-year overall survival and disease-free survival of patients with adenocarcinoma in the presence of lymph node metastasis were 63.2 and 47.4%, respectively, significantly poorer than for squamous cell carcinoma (83.6 and 80.6%; P < 0.001 and P = 0.002, respectively). These were not different in the absence of lymph node metastasis (adenocarcinoma, 93.9 and 92.7%; squamous cell carcinoma, 97.9% and 96.1%; P = 0.067 and P = 0.250, respectively). CONCLUSIONS: The independent significant risk factors for the recurrence and survival of pathologic stage Ib cervical cancer were the presence of lymph node metastasis, large tumor size beyond 4 cm, and histology of adenocarcinoma. The prognosis of patients with adenocarcinoma was poorer than of patients with squamous cell carcinoma in the presence of lymph node metastasis, while the prognosis of pathologic stage Ib cervical cancer was equivalent when there was no metastasis.     

Radical hysterectomy for stage IIB cervical cancer: a review

Patients with stage IIB cervical cancer in some countries in Europe and Asia especially in Japan are usually treated with radical hysterectomy and pelvic lymphadenectomy. Extrauterine diseases, ie, nodal metastases, parametrial invasion, and intraperitoneal spread, can be readily identified. We present the literature review of radical hysterectomy in stage IIB cervical cancer by searching data since 1980 from Medline, and we found that the parametrial involvement of patients in this stage was only 21-55%, the incidence of pelvic node metastases was about 35-45%, and 5-year survival rate was between 55% and 77%. Lymph node metastases and the number of positive nodes were significant prognostic factors of patients in this stage.     

The importance of the histologic processing of pelvic lymph nodes in the treatment of cervical cancer

Four hundred and twenty surgical specimens from patients undergoing radical abdominal hysterectomy and complete pelvic lymphadenectomy for stage Ib, IIa or IIb cervical cancer underwent meticulous histologic and morphometric study. Complete processing of the extirpated lymphatic fatty tissue led to reproducible findings including the number of removed nodes, the number and size of tumor deposits in the nodes, and the location of the latter in the pelvis. An average of 32 nodes was removed per patient regardless of clinical size, tumor size, or stage. Thirty one per cent of patients with stage Ib disease had positive nodes as did 45% of those with stage IIb disease. The number of node metastases increased proportionally with the size of the primary tumor. In stage Ib 30% of the node metastases were smaller than 2 mm in diameter as were 21% of those in stage IIb. The size of the metastases was directly proportional to the size of the primary tumor. In patients with small tumors 43% of the nodes were smaller than 2 mm, as compared with 15% of those in patients with large tumors. The 5-year survival rate of patients with negative nodes was 89.3%. Survival dropped to 69.8% and 37.9% in patients with 1 or ≥ 4 positive nodes, respectively. The 5-year survival rate of patients with node metastases smaller than 2 mm and larger than 20 mm was 70% and 39%, respectively. In patients with identical numbers of positive nodes, survival decreased with increasing tumor size. In patients with tumors of a given size, the number of node metastases was an additional prognostic factor. The number of lymph nodes removed in a given patient is an objective measure of the thoroughness of a lymphadenectomy.     

Twelve-year experience with laparoscopic radical hysterectomy and pelvic lymphadenectomy in cervical cancer

Objectives

This study aims to evaluate the morbidity, oncological outcome, and prognostic factors of cervical cancer patients treated with laparoscopic radical hysterectomy and pelvic lymphadenectomy (LRH).

Methods

Patients with cervical cancer undergoing LRH at the First People's Hospital of Foshan between August 1998 and March 2010 were enrolled in this study. The medical records were reviewed.

Results

A total of 240 patients were identified. According to FIGO stage, the number of patients with stage Ia2, Ib1, Ib2, IIa, and IIb was 2, 163, 34, 35, and 6, respectively. The conversion rate was 1.25%. Intraoperative and postoperative complications occurred in 7.08% and 9.16% patients, respectively. Other medical problems included 74 cases (30%) of bladder dysfunction. Excluding the lost cases, the median follow-up of 221 cases was 35 months, and 5-year survival rate for Ia2, Ib1, Ib2, IIa was 100%, 82%, 66%, 60%, respectively. Univariate analysis showed factors impacting the survival rate were FIGO stage > Ib1, non-squamous histologic type, deep cervical stromal invasion, and lymph node metastasis (P = 0.027, 0.023, 0.007, 0.000). The Cox-proportional hazards regression analysis indicated that only lymph node metastasis (OR = 3.827, P = 0.000) was independent of poor prognostic factor. The 5-year survival rates in Ib1 were 88% with negative lymph nodes and 59% with positive lymph nodes (P = 0.000).

Conclusions

Our data demonstrate that LRH can be performed in stage Ia2-Ib1 or less advanced node negative cervical cancer patients without compromising survival. The feasibility of LRH for more advanced patients needs further investigations.     

Ovarian metastasis in carcinoma of the uterine cervix

BACKGROUND: The present study was conducted to determine the frequency and clinicopathological features of ovarian metastasis in a large population of patients with stage Ib-IIb cervical cancer. METHODS: The study population consisted of 3471 patients with stage Ib to IIb cervical cancer who underwent radical hysterectomy, including pelvic lymphadenectomy and bilateral salpingo-oophorectomy, at our six institutions between 1981 and 2000. To our knowledge, this study is the largest review of patients with ovarian metastasis from cervical cancer. We reviewed the patients' medical records to determine clinicopathological features. RESULTS: Fifty-two patients (1.50%) had ovarian metastases: 6 in stage Ib1, 12 in stage Ib2, 5 in stage IIa, and 29 in stage IIb. The mean age of patients with ovarian metastasis was 49.9 years (range: 29-73 years). The incidence of ovarian metastasis in patients with cervical cancer was 0.22% for stage Ib, 0.75% for stage IIa, and 2.17% for stage IIb with squamous cell carcinoma, and 3.72%, 5.26%, and 9.85%, respectively, in adenocarcinoma. Ovarian metastasis occurred more frequently among patients with adenocarcinoma than among those with squamous cell carcinoma (5.31% vs. 0.79%). Outcome for patients with ovarian metastasis was very poor and not related to FIGO stage and histological type. The presence of ovarian metastasis did not correlate with lymph node involvement or parametrial invasion. CONCLUSION: Study results indicate that ovaries can be preserved in patients with stage Ib-IIa squamous cell carcinoma but removed in all patients with adenocarcinoma.     

Prognostic significance of cervical lesion size and pelvic node metastases in cervical carcinoma.

There were 289 radical hysterectomies performed at Roswell Park Memorial Institute for Stage IB, IIA, and recurrent cervical cancer from 1957 to 1967. The prognostic significance of cervical lesion size, pelvic node metastases, and type of radical hysterectomy have been evaluated. Excellent 5-year survival rates for women with Stage IB cervical carcinoma were associated with cervical lesions measuring less than 3 cm and resected pelvic lymph nodes which did not contain metastatic cancer. In addition, 31% of women with recurrent cervical cancer treated by radical hysterectomy survived 5 years without recurrence.     

Early stage cervical cancer with negative pelvic lymph nodes: pattern of failure and complication following radical hysterectomy and adjuvant radiotherapy

PURPOSE OF INVESTIGATION: The objective was to optimize the adjuvant treatment for patients with lymph node negative cervical cancer by analyzing patterns of failure and complications following radical hysterectomy and adjuvant radiotherapy. METHODS: From September 1992 to December 1998, 67 patients with lymph node negative uterine cervical cancer (FIGO stage distribution: 50 Ib. 17 IIa), who had undergone radical hysterectomy and postoperative adjuvant radiotherapy with a minimum of three years of follow-up were evaluated. All patients received 50-58 Gy of external radiation to the lower pelvis followed by two sessions of intravaginal brachytherapy with a prescribed dose of 7.5 Gy to the vaginal mucosa. For 21 patients with lymphovascular invasion, the initial irradiation field included the whole pelvis for 44 Gy. The data were analyzed for actuarial survival (AS), pelvic relapse-free survival (PRFS), distant metastasis-free survival (DMFS), and treatment-related complications. Multivariate analysis was performed to assess the prognostic factors. RESULTS: The respective five-year AS, PRFS, and DMFS for the 67 patients were 79%, 93% and 87%. Multivariate analysis identified two prognostic factors for AS: bulky tumor vs non-bulky tumor (p = 0.003), positive resection margin (p = 0.03). The independent prognostic factors for DMFS was bulky tumor (p = 0.003), while lymphatic permeation showed marginal impact to DMFS (p = 0.08). The incidence of RTOG grade 1-4 rectal and non-rectal gastrointestinal complication rates were 20.9% and 19.4%, respectively. The independent prognostic factor for gastrointestinal complication was age over 60 years (p = 0.047, relative risk 4.1, 95% CI 1.2 approximately 11.7). The incidence of non-rectal gastrointestinal injury for the patients receiving whole pelvic radiation and lower pelvic radiation was 28.5% and 15.2%, respectively (p = 0.25). CONCLUSION: For patients with lymph node negative cervical cancer following radical hysterectomy, adjuvant lower pelvic radiation appears to be effective for pelvic control. It is also imperative to intensify the strategies of adjuvant therapy for some subgroups of patients.     

Adjuvant combined paclitaxel and carboplatin chemotherapy for glassy cell carcinoma of the uterine cervix: report of three cases with clinicopathological analysis

Glassy cell carcinoma of the uterine cervix (GCC) is a rare form of cervical carcinoma that is characterized by aggressiveness and poor prognosis. We reviewed a variety of clinicopathological features, treatment strategies, and outcomes in three women with GCC. The three patients were successfully treated by radical hysterectomy with pelvic/para-aortic lymphadenectomy. The patients had stage Ib1, stage IIa, and stage Ib2 tumors without lymph node metastases. A 44-year-old woman with stage Ib1 tumor did not undergo adjuvant chemotherapy or radiation therapy. She had recurrent pelvic tumors 12 months after surgery, and died 6 months after the recurrent disease. The histological findings of her cervix, which were different from the other two patients, did not show the marked infiltration of eosinophils. The other two patients with stage Ib2 and IIa tumors underwent adjuvant chemotherapy with paclitaxel and carboplatin, and had disease-free survival for 4.5 and 9 years. We think that all patients with GCC of stage Ib1 or more should undergo adjuvant chemotherapy of paclitaxel and carboplatin or other adjuvant therapies.     

同步放化疗治疗Ib2和IIa2期宫颈癌疗效及预后相关因素分析

目的:探讨同步放化疗治疗Ib2期和IIa2期宫颈癌的疗效和不良反应,并分析预后影响因素。方法:回顾分析2000年1月至2010年12月首都医科大学附属北京妇产医院妇瘤科收治的73例接受同步放化疗的Ib2和IIa2期宫颈癌患者的临床病理资料。统计有效率和疾病控制率评价近期疗效,统计3年、5年无瘤生存率(DFS)及总生存率(OS)评价远期疗效,记录患者的不良反应,并分析可能影响患者预后的相关因素。结果:同步放化疗治疗Ib2期和IIa2期宫颈癌的有效率(CR+PR)为91.78%,疾病控制率(CR+PR+SD)为97.26%;3年DFS为84.93%,0S为86.30%;5年DFS为79.45%,0S为82.19%。所有不良反应患者均可耐受,对症治疗后均可缓解。单因素分析显示,患者的生存率与肿瘤的病理类型、分化程度、大小、有无淋巴结转移以及治疗前后血鳞状细胞癌抗原(SCC-Ag)值有关(P0.05)。多因素分析表明,肿瘤病理类型、大小、有无淋巴结转移及治疗后1个月血SCC-Ag值为远期疗效的独立影响因素。结论:同步放化疗治疗Ib2期和IIa2期宫颈癌的近、远期疗效肯定,不良反应可耐受,是一种可供选择的方法。病理类型为腺癌、肿瘤直径﹥5cm、有淋巴结转移、治疗后1个月血SCC-Ag值≥1.5ng/ml者预后较差,需进一步加强研究。     

子宫颈癌根治术中的淋巴显影和前哨淋巴结识别

目的 探索子宫颈癌根治术中淋巴显影和前哨淋巴结识别的方法及其可行性,评价前哨淋巴结预测盆腔淋巴结有无肿瘤转移的准确性。方法 应用染料法对20例宫颈癌患者(临床分期为Ib期3例、Ⅱa期12例、Ⅱb期5例)在根治术中于宫颈肿瘤周围的正常组织中分4点(3、6、9、12点处)注入美蓝或专利蓝溶液4ml,识别和定位蓝染的淋巴结(即前哨淋巴结),然后再按常规行盆腔淋巴清扫术,所有淋巴结一起送病理检查。结果 20例宫颈癌患者中淋巴管有蓝色染料摄取者18例,共有蓝染淋巴结33枚,其中左侧15枚,右侧18枚,前哨淋巴结识别成功14例,识别率为78％(14／18)。共有6例有淋巴结转移,淋巴结转移率为33％(6／18)。成功识别前哨淋巴结的14例中,淋巴结转移5例,其中前哨淋巴结和盆腔淋巴结均转移者2例,仅有前哨淋巴结转移者3例,准确性为100％,假阴性率为0。结论 宫颈癌根治术中淋巴显影和前哨淋巴结识别技术是可行的,但识别率尚有待提高。     

Prognostic factors affecting disease-free survival in early-stage cervical cancer patients undergoing radical hysterectomy and pelvic-paraaortic lymphadenectomy

OBJECTIVE: This study was performed to identfy surgical and histopathologic prognostic factors that could predict 5-year disease-free survival (DFS) after patients underwent radical hysterectomy and pelvic-paraaortic lymphadenectomy for FIGO Stage I-II cervical carcinoma. METHODS: A retrospective review was performed for all patients undergoing primary radical hysterectomy and pelvic-paraaortic lymphadenectomy for Stage I-II cervical cancer at Ankara Oncology Hospital from 1995 to 2000. Clinical and pathologic variables including age, tumor size (TS), clinical stage, depth of invasion (DI), lymphovascular space involvement (LVSI), cell type, tumor grade, lymph node metastases (LNM), parametrial involvement, surgical margin involvement and pattern of adjuvant therapy were analyzed using univariate analyses. DFS was performed by the Kaplan-Meier method and the log-rank test. Independent prognostic and predictive factors affecting DFS were assessed by the Cox proportional hazard method. RESULTS: Ninety-three patients underwent primary type III radical hysterectomy and pelvic-paraaortic lymphadenectomy. Five-year DFS was 87.1%. LVSI, parametrial involvement and grade were the prognostic factors that independently affected survival. DFS was not significantly different for age, disease status of the surgical margins, tumor size, depth of invasion, cell type, pelvic lymph node metastases and adjuvant radiotherapy. CONCLUSIONS: LVSI, parametrial invasion and histologic grade 2-3 were independent prognostic factors in early-stage cervical cancer patients. Adjuvant radiotherapy in these patients provides no survival advantage.     

髂内动脉灌注新辅助化疗在子宫颈癌治疗中的价值

目的评价髂内动脉灌注新辅助化疗在宫颈癌治疗中的作用。方法对1997年3月—2002年1月间收治的186例巨块型(肿瘤直径≥4cm)宫颈癌随机分为2组,化疗加放疗组105例,经髂内动脉灌注化疗,采用Seldinger技术髂内动脉插管或腹壁下动脉插管2种方法注药,化疗以顺铂为主的联合方案,同时采用192Ir高剂量率腔内后装治疗,A点剂量为12~24Gy,分2~4次;放疗组81例,术前予腔内后装治疗,A点剂量同前。两组患者均于治疗后2周行子宫颈癌根治术。结果化疗加放疗组肿瘤消退总有效率为97 1%,明显高于放疗组的79 0% (P<0 01)。其中,临床Ⅰb期患者中,化疗加放疗组总有效率为100 0%,明显高于放疗组的78 3% (P<0 01 );Ⅱa期患者中,化疗加放疗组总有效率为93 2%、放疗组为79 3%,两组比较,差异无统计学意义(P>0 05);Ⅱb期患者中,化疗加放疗组总有效率为96 1%、放疗组为5 /6,两组比较,差异无统计学意义(P>0 05 )。术后病理检查,宫颈肿瘤残留、宫旁浸润、盆腔淋巴结转移发生率,化疗加放疗组(分别为51 4%、8 6%、7 6% )均明显低于放疗组(分别为79 0%、23 5%、21 0%, P<0 01);而2年内复发率放疗组为23 5%,明显高于化疗加放疗组的6 7% (P<0 01)。2年生存率化疗加放疗组为94 5%、放疗组为84 7%,两组比较,差异无统计学意义(P>0 05)。结论髂内     

Ten-year survival of patients with locally advanced, stage ib-iib cervical cancer after neoadjuvant chemotherapy and radical hysterectomy.

OBJECTIVE(S). The aim of this study was to evaluate the effects of neoadjuvant chemotherapy and radical hysterectomy on long-term survival in stage IB-IIB locally advanced cervical cancer by conducting a 10-year follow-up. METHODS: Between August 1983 and May 1990, 80 locally advanced, stage IB-IIB cervical cancer patients with tumor diameter greater than or equal to 4 cm were treated with neoadjuvant VBP chemotherapy (cisplatin, vinblastine, and bleomycin) followed by radical hysterectomy with pelvic lymphadenectomy. After this therapeutic modality, patients were followed for more than 10 years. Ten-year survival rates and factors affecting recurrence after this therapy were evaluated. RESULTS: Of 80 patients, 75 (93.7%) showed a reduction in tumor size after neoadjuvant chemotherapy. At pathologic examination, stage reduction was noted in 53 (66.2%) patients and 20 patients (25%) showed no residual or microinvasive cervical tumor. Pelvic lymph node metastases were found in 17 patients (21.3%). During the 10-year follow up, 2 patients were lost and 16 patients recurred. Overall 5-year and 10-year disease-free actual survival rates were 82.0 (64/78) and 79.4% (62/78), respectively. Clinical stage, initial tumor size, clinical response, and residual tumor size were not risk factors for recurrence after this therapy. However, pelvic lymph node metastasis was a significant risk factor for recurrence. CONCLUSION(S). Neoadjuvant VBP chemotherapy followed by radical hysterectomy in locally advanced, stage IB-IIB cervical cancer patients seemed to improve the long-term survival rate for these patients compared to that of conventional therapy. However, randomized controlled trials are needed to confirm this result.