Analysis of 1058 Patients with Uterine Cervical Cancer

Mok, Jung Eun; Lee, Dong Hun; Kim, Jong Hyuk; Kim, Yong Man; Kim, Young Tak; Nam, Joo Hyun

Abstract

OBJECTIVES
This study was undertaken to analyze the demographic profile and to identify the clinicopathologic prognostic factors affecting survival rate in patients with cervical cancer.
METHODS
Records of 1058 patients with cervical cancer treated in Asan Medical Center(AMC) from June 1989 to March 1999 were reviewed. All patients were diagnosed and treated initially in AMC, and the patients who transferred after initial treatment from other hospital or who visited AMC after recurrence were excluded. Demographic profile, findings in preoperative work-up, treatment modality, and post-treatment clinical course were evaluated. Of the 1058 patients, 863 patients were primarily treated with surgery, and their operation records were reviewed. 5-year disease free survival rate(DFSR) was calculated according to histopathologic risk factors such as clinical stage, clinical tumor size, depth of cervical wall invasion, histologic type, LN involvement, lympho-vascular space invasion(LVSI), and involvement of resection margin. And their clinical significance as prognostic factors were assessed using multivariate analysis. RESULS & CONCLUSION: The age at diagnosis ranged from 22 to 85 years old, and the mean age was 50.5 years(SD: 12.5). Of the 1058 patients, the number of patients with FIGO stage I disease were 665(62.8%), those with stage II were 318(30.1%), and those with stage III and stage IV were 58(5.5%) and 17(1.6%), respectively. According to pathologic report, 88.1% of the patients had squamous cell carcinoma, 4.8% had adenosquamous cell carcinoma, 4.1% had adenocarcinoma, 1.3% had undifferentiated malignancy, and 1.7% had the other histologic type of malignancy. Of surgically treated 863 patients, LN involvement was present in 8.6% of patients with stage Ia, 15.1% with Ib, 25.0% with IIa and 26.5% with IIb. External iliac LN was the most frequently involved among regional pelvic LN. Bladder dysfunction was the most common complication after surgery, occupying 11.4%. Other surgical complications included lymphocyst formation(8.9%), fistula formation(2.0%), wound disruption(1.8%), intestinal injury(1.1%), vessel injury(0.8%), and ureteral injury(0.5%). 5-year DFSR according to FIGO stage was as follows: Ia 95.7%, Ib 88.9%, IIa 81.8%, IIb 61.8%, III 45.0%, and IV 25.0%. While FIGO stage, histologic type, LN involvement, and involvement of resection margin had prognostic significance in multivariate analysis, clinical tumor size, depth of cervical wall invasion, and LVSI did not.