title: Prognostic difference of surgical treatment of exophytic versus barrel-shaped bulky cervical cancer.
abstract: OBJECTIVE
  The aim of the study was to evaluate the prognostic significance of tumor geography, defined as exophytic or barrel-shaped growth, in bulky (>4 cm) cervical cancer.
  
  
  METHODS
  Four hundred women with cervical cancer, treated by primary radical hysterectomy between January 1984 and November 2000, were followed in a prospective cohort study. Clinical and pathology data were stored in a databank and the clinical protocol was unchanged during the study except for the amendment of additional indications of postoperative radiation in 1997. The assessment of tumor geography was based on pelvic examination at the time of tumor staging or radical hysterectomy or from the pathology report. Survival probabilities were calculated by the Kaplan-Meier method and compared with the log-rank test.
  
  
  RESULTS
  The mean age of the patients was 45 years and the mean follow-up duration 48 months. Tumors were of squamous cell type in 291 patients (73%). Lymph node metastases were present in 91 patients (24%) and postoperative radiation was given in 179 patients (45%). In 291 patients, tumor diameter was <4 cm; in 58 patients, the tumor was defined as bulky exophytic and in 51 patients as bulky barrel shaped. There were no differences among these three groups in terms of operating time, blood loss during surgery or complications at 3 or 6 months postoperatively. Bulky exophytic tumors had an identical overall survival as compared to small-diameter (<4 cm) tumors. The overall survival (OS) of bulky barrel-shaped tumors was significantly worse (P < 10(-4)). The same was found for disease-free survival (DFS).
  
  
  CONCLUSIONS
  Bulky exophytic cervical cancer has an identical surgical morbidity, overall and disease-free survival as compared to nonbulky (<4 cm) cervical cancer. In view of these identical characteristics, primary surgical treatment should be considered for patients with bulky exophytic cervical cancer.
authors.affiliation: Department of Gynecology, Leiden University Medical Center, Leiden 2300RC, The Netherlands. J.B.M.Z.Trimbos@LUMC.nl
authors.forename: J B
authors.initials: JB
authors.lastname: Trimbos
authors.forename: A F
authors.initials: AF
authors.lastname: Lambeek
authors.forename: A A W
authors.initials: AA
authors.lastname: Peters
authors.forename: R
authors.initials: R
authors.lastname: Wolterbeek
authors.forename: K N
authors.initials: KN
authors.lastname: Gaarenstroom
authors.forename: G J
authors.initials: GJ
authors.lastname: Fleuren
authors.forename: G G
authors.initials: GG
authors.lastname: Kenter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002455:Cell Division / Q000502:physiology; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*