Predictive Value of a Proposed Subclassification of Stages I and II Cervical Cancer Based on Clinical Tumor Diameter

Abstract

Hospital records of 4490 patients treated for International Federation of Gynecology and Obstetrics (FIGO) stage IB, IIA, or IIB carcinoma of the cervix between 1960 and 2001 at 1 institution were reviewed. Outcomes were estimated using the Kaplan-Meier method and compared using the log-rank method. A proportional hazards regression model was used to evaluate the relative importance of predictive factors. The rates of disease-specific survival and pelvic disease control were strongly correlated with tumor diameter, FIGO stage, histological subtype, and clinical node status. Regression analysis demonstrated that a diameter of greater than 4 cm, a diameter of greater than 6 cm, FIGO stage II (vs IB), the presence and level of lymph node involvement, and histological subtype were all highly significant independent predictors of poor disease-specific survival. Intermediate tumor-diameter categories (>5 cm or >7 cm) and FIGO stage IIB (vs IB or IIA) did not contribute significant additional information to the model. Only a tumor diameter of greater than 4 cm, a diameter of greater than 6 cm, the presence of lymph node involvement, and histological subtype were independent predictors of pelvic disease control. On the basis of these results, we propose dividing each of the FIGO categories IB, IIA, and IIB into 3 groups according to clinical tumor diameter: (1) less than or equal to 4 cm, (2) 4.1 to 6 cm, and (3) greater than 6 cm. The proposed modified system would provide more accurate prognostic information, facilitate comparisons, and maintain continuity with the current staging system.

Prognostic Parameters for Patients with Cervical Cancer FIGO Stages IA2-IIB: A Long-Term Follow-Up

“…Several years later, Perez et al [19] reported that the size of the primary neoplasm correlated with disease-free survival rates. Others have also confirmed the role of this parameter as an independent prognostic factor for cervical cancer patients [20][21][22][23] . A recent study by Wagner et al [24] revealed that tumor size is the most effective prognostic parameter in early-stage cervical cancer.…”

Advanced Imaging Applications for Locally Advanced Cervical Cancer

“…Patients with tumor size more than 4 cm in diameter showed evidence of 30-80% chance of pelvic lymph node positivity with 47-70 % 5 year survival. In contrast, the patients with tumor size less than or equal to 4 cm showed 15-20% chance of pelvic lymph node positivity with 92-95% 5 year survival (Eifel et al, 2009, Lee et al, 2010. Para-aortic metastasis was found in approximately 20% in stage II disease (Follen et al, 2003).…”

Morbid Obesity as an Independent Risk Factor for Disease-Specific Mortality in Women With Cervical Cancer

“…For multivariate analysis, known prognostic factors such as tumor size > 4 cm and stage IIIB, IVA or tumor size > 7 cm were utilized. [6]…”