title: Pattern of invasion is of prognostic value in surgically treated cervical cancer patients.
abstract: OBJECTIVE
  Different patterns of invasion (representing different grades of tumor cell dissociation) are associated with prognostic outcome in cancer. We evaluated the prognostic value of different patterns of invasion (PI) in cervical carcinomas (CX).
  
  
  METHODS
  Six hundred eleven surgically treated CX (FIGO IB to IIB) were re-evaluated histologically regarding the PI, using a three-level scoring system. Closed PI was defined as cohesive growth with well-delineated (pushing) borders. In finger-like PI the tumor grows in solid cords/trabecles. Highly dissociative growth in small groups or single cells was defined as spray-like PI. Types of PI were correlated to tumor stage, histo-morphologic factors and prognostic outcome.
  
  
  RESULTS
  Sixty percent of the tumors showed a spray-like PI, 30% a finger-like PI and only 7.4% were of the closed type. Spray-like PI showed a significant correlation with advanced stage disease, lymphovascular space involvement, poorly differentiated tumors and pelvic lymph node metastases. Spray-like PI was accompanied by a reduced 5-year overall survival when compared to the finger-like and closed PI (68.7% vs. 80.9% vs. 88.5%; P=0.0004). The prognostic impact of the PI disappeared in node-positive patients (P=0.06) but persisted in patients without pelvic lymph node disease (P=0.03). In multivariate analysis, using COX regression model, the PI represented as independent prognostic factor.
  
  
  CONCLUSIONS
  Spray-like PI (i.e., highest degree of tumor cell dissociation) is associated with advanced tumor stages, increased rate of recurrency and a reduced overall survival. In separate analysis of patients with and without lymph node metastases, the impact of PI persisted only in node-negative cases as a prognostic factor.
authors.affiliation: Institute of Pathology, Division of Gynecologic Pathology, University of Leipzig, Liebigstrasse 26, Leipzig, D-04103, Germany. hornl@medizin.uni-leipzig.de
authors.forename: L-C
authors.initials: LC
authors.lastname: Horn
authors.forename: U
authors.initials: U
authors.lastname: Fischer
authors.forename: G
authors.initials: G
authors.lastname: Raptis
authors.forename: K
authors.initials: K
authors.lastname: Bilek
authors.forename: B
authors.initials: B
authors.lastname: Hentschel
authors.forename: C E
authors.initials: CE
authors.lastname: Richter
authors.forename: U-D
authors.initials: UD
authors.lastname: Braumann
authors.forename: J
authors.initials: J
authors.lastname: Einenkel
mesh_terms: D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D005858:Germany; D006801:Humans; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D010388:Pelvis / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery