The impact of symptoms and comorbidity on prognosis in stage IB cervical cancer.
OBJECTIVE
Like other gynecologic malignancies, cervical cancer is classified by the anatomic location and extent of the tumor. Because clinical variables such as patients' symptoms, symptom severity, and comorbidity may indicate a cancer's biologic virulence and the host-tumor interaction, this study was performed to test the hypothesis that clinical variables will also affect survival of patients with stage IB cervical cancer.


METHODS
From medical records of 251 cases of invasive cervical cancer treated at Yale-New Haven Hospital between 1984 and 1988, information was extracted for patients' demographic characteristics, symptoms, symptom severity, comorbidity, physical findings, laboratory data, treatment, and subsequent course.


RESULTS
In the 122 available cases of stage IB cervical cancer the overall 3-year survival rate was 79%. For a composite clinical predictive system on the basis of symptom status and comorbidity, the 3-year survival rates were as follows: symptomatic patients with comorbidity 58% (seven of 12), either symptomatic or comorbid but not both 77% (46/60), and asymptomatic patients without comorbidity 86% (43/50) (p = 0.02 for linear trend chi 2). When entered into a Cox proportional-hazard model along with other variables that might have an impact on prognosis, the composite symptom-comorbidity stage was the only variable that remained statistically significant.


CONCLUSIONS
These findings demonstrate the importance of clinical variables in estimating prognosis in stage IB cervical cancer. Unless these variables are suitably analyzed, prognostic estimates based only on morphologic studies will be imprecise and therapeutic evaluations may be misleading.
Department of Obstetrics and Gynecology, Women and Infants' Hospital, Brown University School of Medicine, Providence, RI.
J F
JF
Peipert
C K
CK
Wells
P E
PE
Schwartz
A R
AR
Feinstein
D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy