title: Multivariate analysis of histopathologic prognostic factors for invasive cervical cancer treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy.
abstract: BACKGROUND
  The aim of this study was to identify the independent histopathologic prognostic factors for patients with cervical carcinoma treated with radical hysterectomy including paraaortic lymphadenectomy.
  
  
  METHODS
  A total of 187 patients with stage IB to IIB cervical carcinomas treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy were retrospectively analyzed. The median follow-up period was 83 months. Cox regression analysis was used to select independent prognostic factors.
  
  
  RESULTS
  Using multivariate Cox regression analysis, lymph node (LN) status (negative vs. metastasis to pelvic nodes except for common iliac nodes vs. common iliac/paraaortic node metastasis), histopathologic parametrial invasion, lymph-vascular space invasion (LVSI), and histology of pure adenocarcinoma were found to be independently related to patients' poor survival. For patients who had a tumor histologically confined to the uterus and have neither parametrial invasion nor lymph node metastasis, LVSI was the most important prognostic factor, and histologic type, depth of cervical stromal invasion, and tumor size were not related to survival. The survival of patients with a tumor extending to parametrium or pelvic lymph node(s) was adversely affected by histology of pure adenocarcinoma. When the tumor extended to common iliac or paraaortic nodes, patients' survival became quite poor irrespective of LVSI or histologic type of pure adenocarcinoma. Patients' prognosis could be stratified into low risk (patients with a tumor confined to the uterus not associated with LVSI: n = 80), intermediate risk (patients with a tumor confined to the uterus associated with positive LVSI, and patients with squamous/adenosquamous carcinoma associated with pelvic lymph node metastasis or parametrial invasion: n = 86), and high risk (patients with pure adenocarcinoma associated with pelvic lymph node metastasis or parametrial invasion, and patients with common iliac/paraaortic node metastasis: n = 21) with an estimated 5-year survival rate of 100 +/- 0 (mean +/- SE)%, 85.5 +/- 3.9%, and 25.1 +/- 9.7%, respectively.
  
  
  CONCLUSIONS
  LN status, parametrial invasion, LVSI, and histology of pure adenocarcinoma are important histopathologic prognostic factors of cervical carcinoma treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy. Prognosis for patients with cervical carcinoma may be stratified by combined analysis of these histopathologic prognostic factors. Postoperative therapy needs to be individualized according to these prognostic factors and validated for its efficacy using randomized clinical trials.
authors.affiliation: Department of Obstetrics and Gynecology, Hokkaido University School of Medicine, Sapporo 060-8638, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Takeda
authors.forename: Noriaki
authors.initials: N
authors.lastname: Sakuragi
authors.forename: Mahito
authors.initials: M
authors.lastname: Takeda
authors.forename: Kazuhira
authors.initials: K
authors.lastname: Okamoto
authors.forename: Michiya
authors.initials: M
authors.lastname: Kuwabara
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Negishi
authors.forename: Mamoru
authors.initials: M
authors.lastname: Oikawa
authors.forename: Ritsu
authors.initials: R
authors.lastname: Yamamoto
authors.forename: Hideto
authors.initials: H
authors.lastname: Yamada
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Fujimoto
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012044:Regression Analysis; D012186:Retroperitoneal Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*