Clinicopathologic analysis and prognosis of uterine cervical cancer

Lim, Myong Cheol; Lee, Seon Kyung; Park, Seong Jae; Kim, Seung Bo

Abstract

OBJECTIVE
The object of this retrospective study was to evaluate the clinical characteristics and prognosis of invasive uterine cervical cancer.
METHODS
445 evaluable patients with invasive cancer of the cervix were treated at Kyung Hee Medical Center from March 1984 to March 1998. In this retrospective study, we studied the clinico-pathologic characteristics (age, FIGO stage, histologic type, nodal metastasis, and treatment modalities et al) by the review of medical records.
RESULTS
1. The age distribution among the 445 patients ranged from 27 to 90 years, mostly at 51-60 years, which occupied 26.5%. The mean age was 48.9 years. 2. The frequent number of pregnancies was 3-4 times, which occupied 33.3%. The mean number of pregnancies was 5.3 times. The frequent number of deliveries was 3-4 times, which occupied 41.7%. The mean number of deliveries was 3.2 times. 3. Subdivision of 445 cases of invasive cervical carcinoma were made according to the FIGO clinical staging: Stage Ia 77 cases (17.3%), Stage Ib 156 cases (35.0%), Stage IIa 95 cases (21.3%), and Stage IIb 52 cases (11.7%), Stage III 40 cases (9.0%), and Stage IV 25 cases (5.6%). 4. Histologically, squamous cell carcinoma comprised 91.2%, adenocarcinoma 6.6%, adenosquamous carcinoma 1.7%, and others 0.5%. 5. The types of treatment were as follows; operation 36.2%, operation with chemoradiation 13.8%, operation with radiotherapy 11.4%, operation with chemotherapy 11.0%, radiation 8.8%, chemoradiation 6.9%, and others 12.0%. 6. All the excised pelvic and para-aortic lymph nodes (LN) were histologically examined and the incidence of metastasis by clinical stage showed as follows. In Stage Ib 16.4%, 2.3%, in Stage IIa 24.5%, 3.2%, and in the stage IIb 26.7%, 6.7% respectively. The most frequently involved LN among regional pelvic LN is the obturator LN (32%) followed by the external iliac LN (29%). 7. Based on the 445 cases who were available to follow up 5 years or more after treatment, survival rates were studied and analyzed. 5 year survival rate by stage revealed 96% in stage Ia, 87.3% in stage Ib, 81.3% in stage IIa, 72% in stage IIb, 47% in stage III, and 26.4% in stage IV.
CONCLUSION
FIGO stage, involvement of resection margin, and LN involvement had prognostic significance in multivariate analysis (p<0.01). However, tumor size, histologic type, depth of cervical wall invasion, and lymphovascular space invasion did not.