title: Clinical and histopathologic factors related to prognosis in primary squamous cell carcinoma of the vagina.
abstract: The goal of this retrospective study concerning primary carcinoma of the vagina (PCV) was to analyze clinical and histopathologic prognostic factors in one of the largest known material, which comprised 314 patients. PCV is a rare disease, and the majority of published studies are based on small materials; therefore, the established knowledge concerning prognostic factors is insufficient. Routine treatment is based on irradiation with risk for undertreatment or overtreatment, which leads to unnecessary complications in the absence of prognostic factors. The overall 5-year disease-specific survival rate in this study was 45% and in stage I 75%. In the univariate statistical analysis, several factors correlated significantly with disease-specific survival. However, in the multivariate analysis, there were only three factors that independently could predict poor survival-high age at diagnosis, large tumors (> or =4 cm), and advanced stage. Common background factors with no prognostic significance were prior hysterectomy, other gynecological malignancies, and pelvic irradiation. In conclusion, this study has elucidated three strong prognostic factors that might be considered in the choice of therapy and also for modification of the FIGO guidelines. Increased knowledge concerning complementary biologic markers to discriminate between low- and high malignant tumors is however of great importance.
authors.affiliation: Department of Gynecological Oncology, Radiumhemmet and Department of Hospital Physics, Karolinska University Hospital, S-17176 Stockholm, Sweden. kristina.hellman@onkpat.ki.se
authors.forename: K
authors.initials: K
authors.lastname: Hellman
authors.forename: M
authors.initials: M
authors.lastname: Lundell
authors.forename: C
authors.initials: C
authors.lastname: Silfverswärd
authors.forename: B
authors.initials: B
authors.lastname: Nilsson
authors.forename: A-C
authors.initials: AC
authors.lastname: Hellström
authors.forename: B
authors.initials: B
authors.lastname: Frankendal
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology* / Q000532:radiotherapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014625:Vaginal Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000532:radiotherapy