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.

Cervix carcinoma; Prognostic factors; Radical hysterectomy; Disease-free survival

[I] Averette H.E., Nguyen H.N., Donato D., Penalver M.A., Sevm B. U., Estape R., Little W.A.: "Radical hysterectomy for early inva­sive cervical cancer: a 25-year prospective experience with the Miami tecnique". Cancer, 1993, 71, 1422

[2] Sevin B.U., Nadji M., Lampe B., Lu Y., Hilsenbeck S., Koechli 0., Averette H.E.: "Prognostic factors in early stage cervical carci一 noma treated with radical hysterectomy". Cancer, 1996, 76, 1978.

[3] Sevin B.U., Nadji M., Averette H.E., Hilsenbeck S., Smith D., Lampe B.: "Microinvasive carcinoma of the cervix". Cancer, 1992, 70, 2121.

[4] Sevin B.U., Method M.W., Nadji M., Lu Y., Avarette H.E.: "Small cell carcinoma of the cervix treated with radical hysterectomy". Cancer, 1996, 77, 1489

[5] Kamura T., Tsukamoto N., Tsuruchi N., Saito T., Matsuyama T., Akazawa M.S., Nakano H.: "Multivariate analysis of the 扣stopathologic prognostic factors of the cervical cancer in patients undergoing radical hysterectomy". Cancer, 1992, 69, I 81

[6] Delgado G., Bundy B., Zaino R., Sevin B.U., Creasman W.T., 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

[7] Gauthier P., Gore I.. Shingleton H.M., Soong S.J., Orr J.W., Hatch K. D.: ·'Identification of histopathologic risk groups in Stage IB squamous cell carcinoma of the cervix". Obstet. Gynecol., 1985, 66. 569.

[8] Sevin B.U., Lu Y., Bloch D.A., Nadji M., Koechli O.R., Averette H. E.: "Surgically defined prognostic parameters in patients with early cervical carcinoma". Cancer, 1996, 78, 1438.

[9] Estape R.E., Angioli R., Madrigal M., Janicek M., Gomez C. Penalver M., Averette H.: "Close vaginal margins as a prognostic factor after radical hysterectomy". Gynecol. Oncol., 68, 229.

[10] J Inoue T., Mortia K.:'The prognostic significance of number of positive nodes in cervical carcinoma Stage IA, IIA, IIB". Cancer, 1990, 65, 1923.

[11] Burghardt E.，和ckel H., Haas J.. Lahouson M.: "Prognostic factors and operative treatment of Stage IB to IIB cervical cancer". Am. J. Obstet. Gynecol., 1987, 156, 988.

[12] Peters W.A., Lin P.Y., Barret R.J., Stock R.J.. Monk B.J., Berek J.S. et al.: "Concurrent chemotherapy and pelvic radiation therapy compared wIth pelvIC radiation? therapy alone as adjuvant therapy after radical surgery in high risk early stage cancers of the cervix". J. Clin. Oneal., 2000, 18, 1606

[13] Friedberg V.: "Operative therapy for stage lb cervical cancer". In: Burghardt E., Monaghan J.M. (eds.). Operative Treatment of Cer­vical Cancer. Bailliere's Clinical Obstetrics and Gynaecology, vol 2/4. Eastbourne, UK: Bailliere Tindall, 1988, 973.

[14] Ho C.M., Chien T.Y., Huang S., Wu CJ., Shih B.Y., Chang S.C.: "Multivariate analysis of the prognostic factors and outcomes in early cervical cancer patients undergoingradical hysterectomy" Gynecol. Oneal., 2004, 93, 458

[15] Van Nagel! J.R., Donaldson E.S., Wood E., Parker J.: "The signif­icance of vascular invasion and lymphatic infiltration in invasive cervical cancer". Cancer, 1978, 4/, 228.

[16] Inoue T., Okumura M.: "Prognostic significance of parametrial extention in patients with cervical carcinoma Stages IB, IIA, and IIB: A study of 628 cases treated by radical hysterectomy and lym­phadenectomy with or without postoperative irradiation". Cancer, 1984, 54, 1714.

[17] Yuan C., Wang P., Lai C., Tsu E., Yen M., Ng H.: "Recurrence and survival analyses of 1,115 cervical cancer patients treated with radical hysterectomy". Gynecol. Obstet. Invest., 1999, 47, 127.

[18] Winter R., Haas J., Reich 0., Lahousen M., Tamussino K.: "Prog­nostic significance of parametrial involvement in cervical cancer" CMEJ. Gynecol. Oncol., 2001, 6, 204.

[ 19] Smiley L.M., Burke T.W., Silva E.G., Morris M., Gershenson D. M., Wharton J.T.: "Prognostic factors in Stage IB squamous cer­vi cal cancer patients with low risk for recurrence". Obstet. Gynecol., 1991, 77, 271.

[20] Reagan J.W., Fu Y.S.: "Histologic types and prognosis of cancers of the uterine cervix". Int. J. Radiat. Oneal. Biol. Phys., 1979, 5, 1015.

[21] Sedlis A., Bundy B.N., Rotman M.Z., Lentz S.S., Muderspach L.l., Zaino R.J.: "A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with Stage 1B carci­noma of the cervix after radical hysterectomy and pelvic lyphadenectomy: a Gynecologic Oncology Group Study" Gynecol. Oneal., 1999, 73, 177.

[22] Ayhan A., Al R.A., Baykal C., Demirta􀀵 E., Ayhan A., Yiice K.: "Prognostic factors in FIGO Stage 1B cervical cancer without lymph node metastasis and the role of adjuvant radiotherapy after radical hysterectomy". Int. J. Gynecol. Cancer, 2004, 14, 286.