Objective. To evaluate how the independent predictors of recurrence f or stage IB2 cervical cancers treated with up-front radical hysterectomy apply to establ ished risk models. Methods. Patients with IB2 cervical can...Objective. To evaluate how the independent predictors of recurrence f or stage IB2 cervical cancers treated with up-front radical hysterectomy apply to establ ished risk models. Methods. Patients with IB2 cervical cancers diagnosed from 19 90 to 2000 were identified from tumor registries of two institutions. Patients w ere classified into risk groups: high-risk (HR) (positive nodes, parametria, or margins), intermediate-risk (IR) (positive lymph vascular space involvement (L VSI) with any cervical stromal invasion (CSI), or (-) LVSI and > middle-CSI), or low-risk (LR) (absence of HR or IR characteristics). Disease free survival ( DFS) was estimated by Kaplan-Meier method and comparisons between subgroups wer e studied by log rank. A Cox proportional hazards model was used to determine in dependent predictors of recurrence. Results. We identified 86 patientswith stage IB2 tumors treated by RH.We found 34%of patients to be HR, 60%IR, and 6%LR. Of the 52 IR patients, 28 had (+) LVSI with superficial, middle, and outer 1/3 CSI, and 24 had (-) LVSI with middle or outer 1/3 invasion. Overall, postoperat ive adjuvant radiation (PRT) was used in 52%of the 86 patients, including 0/5 L R, 16/52 IR, and 29/29 HR patients. Univariate predictors of recurrence were pel vic nodal disease, (+) LVSI, (+) parametria, outer 1/3 CSI, and tumor size > 6 cm. Age, grade, histology, and the use of postoperative radiation were not asso ciated with recurrence. Multivariate analysis identified LVSI as the only indepe ndent predictor of recurrence (RR 5.2, P = 0.03). Two-year DFS for LR, IR, and HR patients was 100%, 83%, and 60%, respectively. Only 4/24 (17%) IR patient s with (-) LVSI got PRT compared with 12/28 (43%) of IR patients with (+) LVSI. The 2-year DFS for IR patients with (-) LVSI was 96%. IR (+) pa tients recurred more frequently with a 2-year DFS of 71%. Conclusions. Overall , 66%of patients with IB2 disease were classified as having low or intermediate -risk disease. IR patients with (-) LVSI and all LR patients did well with sur gery alone. This study defines the independent importance of LVSI and questions the utility of published IR models when applied to stage IB2 cervical cancer.展开更多
To compare stages IB1and IB2cervical cancers treated with radical hysterectomy (RH)and to define predictors of nodal status and recurrence.Patien ts with stage IB cervical cancers undergoing RH between 1990a nd 2000we...To compare stages IB1and IB2cervical cancers treated with radical hysterectomy (RH)and to define predictors of nodal status and recurrence.Patien ts with stage IB cervical cancers undergoing RH between 1990a nd 2000were e-valuated and clinicopathological v ariables were abstracted.The perioperative complication rate,estimated blood loss(EBL),and OR time were also tabulated.Variables were analyzed usingχ 2 and t tests.Disease -free survival(DFS)was calculated by Kaplan -Meier meth od.Multi-variate analysis was performed via s tepwise logistic regres-sion.Cox -proportional hazards were used to identify in-dependent predictors of recurrence.RH was performed on109stage IB1and 86stage IB2patient s.Mean age,EBL,and perioperative complication rates were similar.Overall,38patients(14IB1vs.24IB2)had positive nodes(P =0.01)including 9patients with positive p ara -aortic nodes(2IB1and 7IB2).Parametrial involvement (PI )and outer 2/3depth of invasion(DOI )were significantly more common in the IB2tumors as well.Patients with IB2dis-ease received adjuvant radiation mo re frequently than IB1patients(52%vs.37%,P =0.04).Univariate predic-tors of nodal status included lymphovascular space in-volvement (LVSI )(P =0.001),DOI (P =0.011),PI (P =0.001),and stage(P =0.011).Multivariate analysis identified only LVSI (OR 6.4,CI 2.4-17,P =0.0002)and PI (OR 8,CI 3.1-20,P =0.0001)as independent predictors of positive nodes.With a median follow -up of 35months,estimates of DFS revealed tumor size(P =0.008),nodal status(P =0.0004),LVSI (P =0.002),PI (P =0.004),and DOI (P =0.0004)as significant univariate predictors.Neoadjuvant chemothera-py,age,grade,histology,and adjuvant radiation were not associated with recurrence.The significant indepen-dent predictors of DFS were LVSI (ROR 5.7,CI 2-16,P =0.0064)and outer 2/3DOI (OR 5.8,CI 2-20,P =0.0029).Neither tumor size nor nodal status was a significant predictor of DFS.The pr ognosis in stage IB cervical cancer seems to be most infl uenced by presence of LVSI and DOI and not by tumor size as th e staging criteria would suggest.These factors are best determined patho-logically after radical hysterecto my.This report contains the largest comparison of IB1and IB2patients managed by RH.Tumor size failed to predict recu rrence or nodal status when stratified by LVSI,DOI,and PI.Treatment deci-sions based on tumor size alone shoul d be reconsidered.展开更多
文摘Objective. To evaluate how the independent predictors of recurrence f or stage IB2 cervical cancers treated with up-front radical hysterectomy apply to establ ished risk models. Methods. Patients with IB2 cervical cancers diagnosed from 19 90 to 2000 were identified from tumor registries of two institutions. Patients w ere classified into risk groups: high-risk (HR) (positive nodes, parametria, or margins), intermediate-risk (IR) (positive lymph vascular space involvement (L VSI) with any cervical stromal invasion (CSI), or (-) LVSI and > middle-CSI), or low-risk (LR) (absence of HR or IR characteristics). Disease free survival ( DFS) was estimated by Kaplan-Meier method and comparisons between subgroups wer e studied by log rank. A Cox proportional hazards model was used to determine in dependent predictors of recurrence. Results. We identified 86 patientswith stage IB2 tumors treated by RH.We found 34%of patients to be HR, 60%IR, and 6%LR. Of the 52 IR patients, 28 had (+) LVSI with superficial, middle, and outer 1/3 CSI, and 24 had (-) LVSI with middle or outer 1/3 invasion. Overall, postoperat ive adjuvant radiation (PRT) was used in 52%of the 86 patients, including 0/5 L R, 16/52 IR, and 29/29 HR patients. Univariate predictors of recurrence were pel vic nodal disease, (+) LVSI, (+) parametria, outer 1/3 CSI, and tumor size > 6 cm. Age, grade, histology, and the use of postoperative radiation were not asso ciated with recurrence. Multivariate analysis identified LVSI as the only indepe ndent predictor of recurrence (RR 5.2, P = 0.03). Two-year DFS for LR, IR, and HR patients was 100%, 83%, and 60%, respectively. Only 4/24 (17%) IR patient s with (-) LVSI got PRT compared with 12/28 (43%) of IR patients with (+) LVSI. The 2-year DFS for IR patients with (-) LVSI was 96%. IR (+) pa tients recurred more frequently with a 2-year DFS of 71%. Conclusions. Overall , 66%of patients with IB2 disease were classified as having low or intermediate -risk disease. IR patients with (-) LVSI and all LR patients did well with sur gery alone. This study defines the independent importance of LVSI and questions the utility of published IR models when applied to stage IB2 cervical cancer.
文摘To compare stages IB1and IB2cervical cancers treated with radical hysterectomy (RH)and to define predictors of nodal status and recurrence.Patien ts with stage IB cervical cancers undergoing RH between 1990a nd 2000were e-valuated and clinicopathological v ariables were abstracted.The perioperative complication rate,estimated blood loss(EBL),and OR time were also tabulated.Variables were analyzed usingχ 2 and t tests.Disease -free survival(DFS)was calculated by Kaplan -Meier meth od.Multi-variate analysis was performed via s tepwise logistic regres-sion.Cox -proportional hazards were used to identify in-dependent predictors of recurrence.RH was performed on109stage IB1and 86stage IB2patient s.Mean age,EBL,and perioperative complication rates were similar.Overall,38patients(14IB1vs.24IB2)had positive nodes(P =0.01)including 9patients with positive p ara -aortic nodes(2IB1and 7IB2).Parametrial involvement (PI )and outer 2/3depth of invasion(DOI )were significantly more common in the IB2tumors as well.Patients with IB2dis-ease received adjuvant radiation mo re frequently than IB1patients(52%vs.37%,P =0.04).Univariate predic-tors of nodal status included lymphovascular space in-volvement (LVSI )(P =0.001),DOI (P =0.011),PI (P =0.001),and stage(P =0.011).Multivariate analysis identified only LVSI (OR 6.4,CI 2.4-17,P =0.0002)and PI (OR 8,CI 3.1-20,P =0.0001)as independent predictors of positive nodes.With a median follow -up of 35months,estimates of DFS revealed tumor size(P =0.008),nodal status(P =0.0004),LVSI (P =0.002),PI (P =0.004),and DOI (P =0.0004)as significant univariate predictors.Neoadjuvant chemothera-py,age,grade,histology,and adjuvant radiation were not associated with recurrence.The significant indepen-dent predictors of DFS were LVSI (ROR 5.7,CI 2-16,P =0.0064)and outer 2/3DOI (OR 5.8,CI 2-20,P =0.0029).Neither tumor size nor nodal status was a significant predictor of DFS.The pr ognosis in stage IB cervical cancer seems to be most infl uenced by presence of LVSI and DOI and not by tumor size as th e staging criteria would suggest.These factors are best determined patho-logically after radical hysterecto my.This report contains the largest comparison of IB1and IB2patients managed by RH.Tumor size failed to predict recu rrence or nodal status when stratified by LVSI,DOI,and PI.Treatment deci-sions based on tumor size alone shoul d be reconsidered.
