Tumor size is of prognostic value in surgically treated FIGO stage II cervical cancer
Introduction
The approach to the treatment of cervical carcinoma (CX) depends primarily on the stage of the disease, the age of the patient and comorbidity. Pretreatment evaluation of prognostic factors is essential for treatment planning. Tumor diameter has been proposed as an important prognostic factor in patients with CX by many authors since several years [1], [2], [3], [4]. As a consequence, a new FIGO-staging system for CX confined to the cervix was introduced in 1995 [5], defining two subgroups based on tumor diameter (FIGO IB1: maximum tumor size ≤ 4 cm; FIGO IB2: tumors > 4 cm). The prognostic impact of this substaging was confirmed during the following years [4], [6], [7], [8]. In this context, earlier studies have suggested that there might be a difference in determining the tumor size by using tumor length (i.e. vertical extension) and the tumor width [9], [10]. The results of these studies suggested that the tumor width might be of more impact in predicting pelvic lymph node involvement and disease free as well as overall survival. The following studies, cited above, have not considered this subtle measurement for determination of the tumor size in CX.
In tumors with extrauterine extension (FIGO stage II), tumor size is also of prognostic impact and valuable for treatment decision, but the knowledge is limited [8], [11], [12], [13]. The present study was designed to analyze the prognostic impact of tumor size in surgically treated CX with extrauterine extension with detailed recognition of tumor length and tumor width.
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Materials and methods
Data from patients with CX, staged FIGO IIA and IIB were obtained from the files of our so-called Wertheim-Archive [14]. This archive contains all morphologic data from CX which were treated by primary radical hysterectomy between 03/1979 and 12/1996 with tumor stage > pT1b1.
Patients who received neoadjuvant therapy, those with incomplete local tumor resection (R1 or R2 resection) and tumors of other histologic types as squamous cell and adenocarcinomas were excluded from the study. All women
Results
245 patients were included in the study. Their characteristics are given in Table 1. The median follow-up time was 54 months (95% confidence interval 45.4 to 62.6 months).
113 of the patients (46.1%) represented tumors larger than 4 cm in the largest tumor extension (i.e. bulky disease).
60.2% (68/113) of the patients with bulky disease showed pelvic lymph node involvement compared to 42.4% (56/132) in patients with non-bulky tumors (p = 0.006). The odds ratio of 2.2 (95% CI: 1.3–3.6) indicates a
Discussion
There is important evidence that the tumor size is of prognostic impact in non-gynecological malignancies at different sites, e.g. in esophageal and renal cell carcinoma [23], [24] as well as for carcinoma of the cervix uteri [1], [2], [4], [6], [25].
Because of the fact that the majority of CX will be diagnosed in early stage disease in the Western countries, studies regarding tumor size have been focused on FIGO stage I disease [3], [4], [7]. All these studies have reported that bulky tumors
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