Prognosis and prognostic factors in node-negative cervix cancer

Abstract

Relapse rates, mortality rates and possible prognostic factors were assessed in women with early‐stage, node‐negative cervix cancer. We identified 194 women who had a radical hysterectomy with histopathologically confirmed negative lymph nodes as primary treatment for FIGO stages IB and IIA cervix cancer between 1981 and 1990, at a single tertiary referral oncology centre. Each patient’s pathology was reviewed by two pathologists blinded to patient outcome. Clinical and demographic details were abstracted from medical records by a single observer blinded to patient outcome. Median follow‐up was 5.3 years and 95% were followed for longer than 2 years. Prognostic significance for relapse‐free survival was assessed with Cox’s proportional hazards model. There were 27 relapses (relapse‐free survival probability of 85% (95% confidence interval (CI): 79–90)) and 19 deaths (overall survival probability 86% (95% CI: 78–93)), of which 17 were due to cervix cancer (cervix cancer specific survival probability 87% (95% CI: 80–94)). Nuclear grade 2 or 3 (P = 0.02) and small‐cell squamous histology (P = 0.01) were each associated with about a four‐fold increase in the risk of recurrence, while lymphatic permeation (P = 0.02), age less than 36 years (P = 0.03) and either tumor size> 28 mm (P = 0.03) or surgical clearance < 5 mm (P = 0.02) were each associated with about a 2.5‐fold increase in the risk of recurrence. Adverse histologic features, young age and large tumor size were independent predictors of increased recurrence rates in these women with early‐stage cervix cancer.

Do the pelvic lymph nodes predict the parametrial status in cervical cancer stages IB–IIA?

“…We found in our study that parametria were involved either by direct extension or in their lymph nodes in around 15% in the whole series, including patients with positive and negative pelvic lymph nodes, and in 36.4% when considering only patients with positive pelvic nodes. Although these figures are comparable with that of previous publications (30)(31)(32)(33)(34)(35)(36) , we found that the direct parametrial involvement from the tumoral cervix was higher than the affection of lymphatic vessels or nodes in the parametria (68.7 versus 31.3%). This is different from the previous published data using the interesting giant-section histological technique introduced by Burghardt and Pickel (27) some years ago that many groups of investigators have utilized for the parametrial study.…”

Prognostic factors in surgically treated stage IB-IIB carcinoma of the cervix with negative lymph nodes

“…More reproducible methods using automated morphometry‐based systems have, however, also been unhelpful( 12, 13). A more recent study, including full histopathologic review by two pathologists in a node negative population, indicated a fourfold increase in the recurrence rate for patients with a grade 2 or 3 tumor( 14). Our findings are, however, in general concordance with the opinion that routinely obtained tumor grade is not predictive of recurrence in a lymph node negative population.…”

Do the pelvic lymph nodes predict the parametrial status in cervical cancer stages IB-IIA?

“…We found in our study that parametria were involved either by direct extension or in their lymph nodes in around 15% in the whole series, including patients with positive and negative pelvic lymph nodes, and in 36.4% when considering only patients with positive pelvic nodes. Although these figures are comparable with that of previous publications ( 30–36 ) , we found that the direct parametrial involvement from the tumoral cervix was higher than the affection of lymphatic vessels or nodes in the parametria (68.7 versus 31.3%). This is different from the previous published data using the interesting giant‐section histological technique introduced by Burghardt and Pickel ( 27 ) some years ago that many groups of investigators have utilized for the parametrial study.…”

“…In relation to the patients with negative pelvic lymph nodes, we found that between 85 patients with such condition, 77 patients (90.6%) had negative parametria and eight patients (9.4%) had positive parametria – similar or larger than other publications ( 3,17,36,43 ) – presenting statistical difference with positive pelvic nodes patients, and good specificity and good negative predictive value. Between these eight patients, three patients had parametrial positive nodes, and five direct parametrial compromise.…”

“…It is not easy to find studies about the predictor value of pelvic lymph nodes upon parametria, especially in patients with negative pelvic lymph nodes, and therefore our results are difficult to compare. Previous studies have been mainly focused on survival ( 36,43 ) or on prognostic factors such as tumoral size, tumoral histological features, parametrial involvement, and subsequent pelvic lymph nodes status ( 3,16,35,36,44,45,46 ) . We have seen that the univariate analysis of our data (deep tumoral invasion, tumoral volume, positive nodes, and positive LVSI) shows significance for parametrial involvement of all factors, which the multivariate analysis also did, suggesting that all variables are associated.…”