Comerci G, Bolger BS, Flannelly G, Maini M, de Barros Lopes A, Monaghan JM. Prognostic factors in surgically treated stage IB-IIB carcinoma of the cervix with negative lymph nodes. Int J Gynecol Cancer 1998; 8: 23-26. Two hundred and seventy-five females with stage IB-IIB negative lymph node cervical cancer, treated between January 1988 and December 1994 by radical hysterectomy and pelvic lymph node dissection, form the basis of this analysis. The clinical records were reviewed for all patients including histopathology, clinical features at presentation, and follow-up. Tumors were re-staged according to the 1995 FIGO classification. Median follow-up was 55 months and 85.8% were followed for longer than two years. There were 21 recurrences, 12 of which were true central recurrence (disease-free survival at 5 years: 91.66%). Fifteen of 25 deaths were due to cervical cancer (crude survival at 5 years: 93.27%). In univariate log-rank analysis, stage (P = 0.005), tumor size (P = 0.0002), and lymph-vascular space involvement (LVSI) (P = 0.01) appeared to be statistically significant factors for tumor recurrence. Other factors including age, histology type, differentiation, adjacent cervical intraepithelial neoplasia or cervical glandular intraepithelial neoplasia, and presence of intraepithelial disease at resection margin were not found to be statistically significant. In multivariate analysis (Cox regression) tumor size (P = 0.02) and LVSI (P = 0.03) were the only independent variables. In the presence of negative lymph nodes and complete surgical excision, tumor size and LVSI are important predictors of local recurrence.

Maini M, Lavie O, Comerci G, Cross PA, Bolger B, Lopes A, Monaghan JM. The management and follow‐up of patients with high‐grade cervical glandular intraepithelial neoplasia. Int J Gynecol Cancer 1998; 8: 287–291. The purpose of this study was to evaluate if the status of the margins on large loop excision of the transformation zone (LLETZ) can predict the presence of residual cervical glandular intraepithelial neoplasia (CGIN) and to assess the efficacy of cervical conization as primary management of CGIN. Between January 1989 and March 1997 fifty patients with a diagnosis of CGIN made by LLETZ were treated in the Department of Gynaecological Oncology at the Queen Elizabeth Hospital, Gateshead. Presence or absence of CGIN at cone margins, results of cervical cytological examinations before and following conization, colposcopic examination, and results of histopathologic assessment of any surgical specimens taken after initial cone biopsy were analyzed in this study. Of the 50 patients with CGIN, managed by conization, in 34 (68%) CGIN was present at the surgical margins and in 16 (32%) the margins were clear. Eleven (32.3%) patients with CGIN at the margins of excision had evidence of residual disease and there was only one of the 16 (6.25%) patients with clear margins (P= 0.03). Two cases of invasive adenocarcinoma were identified in the group of patients with positive margins. In a mean follow‐up time of 32.35 months, no case of invasive carcinoma was identified in the completely excised group. In our retrospective study LLETZ was found to be an adequate primary management for CGIN, and the excision margin status of the LLETZ specimen did appear to be a prognostic factor for residual disease.

Dawlatly B, Lavie O, Cross PA, Maini M, Lopes A, Monaghan JM. Prognostic factors in surgically‐treated stage IB–IIB squamous cell carcinoma of the cervix with positive lymph nodes. Int J Gynecol Cancer 1998; 8: 467–470. The aim of this study was to define possible prognostic factors in patients with squamous cell carcinoma of the cervix with lymph node metastases. Between December 1985 and December 1994, 527 patients with FIGO stage IB–IIB cervical cancer treated with radical hysterectomy and pelvic lymph node dissection were identified from the departmental database; 102 of these (19.35%) cases were found to have lymph node metastases. Histological specimens were available in 81 cases, 63 of which were pure squamous cell carcinoma (SCC), and these form the basis of this analysis. Tumors were re‐staged according to the 1995 FIGO classification. The mean follow‐up was 54 months, and 51 patients (81%) were followed up for more than 2 years, while 12 patients (19%) died within two years of surgery. There were 32 recurrences (51%) during the follow‐up period, and 26 of 29 deaths in the study population were due to cervical cancer. In univariate log rank analysis, tumor differentiation (P= 0.011), number of positive lymph nodes (P= 0.021), and extent of metastatic disease in positive lymph nodes (P= 0.035) were statistically significant factors for crude survival. Other factors including age, maximum diameter of the primary tumor, lymph vascular space involvement, completeness of excision, extracapsular spread, unilateral or bilateral node involvement, inflammatory reaction and maximum diameter of the largest metastases were not found to be statistically significant. In multivariate analysis (Cox regression) differentiation of primary tumor and extent of metastatic disease were the only independent variables (P= 0.009 and P= 0.045, respectively). In the group of patients with poorly differentiated SCC and extent of metastatic disease of 20 mm or more, 78% died of disease, while in the group with moderately differentiated SCC and extent of metastatic disease of less than 20 mm, only 23% died of disease (P= 0.0017). For patients with only one of the two risk factors, 45 % died of disease. In the presence of positive lymph nodes, differentiation of the primary tumor and the extent of lymph nodes metastases are important factors for risk of death due to cervical cancer.