title: Tumor size is of prognostic value in surgically treated FIGO stage II cervical cancer.
abstract: OBJECTIVE
  Tumor size is a well recognized prognostic factor in early stage cervical carcinoma (CX). However, limited knowledge exists about the value of tumor size in surgically treated CX with extrauterine extension.
  
  
  METHODS
  245 cases of local advanced CX (FIGO stage IIA and IIB) who received upfront surgery were evaluated regarding tumor size, regarding the prediction of pelvic lymph node involvement and recurrence free and overall survival during a median follow-up time of 54 months (95% CI 45.4-62.6 months). Tumors larger than 4 cm were defined as bulky stage disease.
  
  
  RESULTS
  Bulky disease was seen in 46.1% (113/245). 60.2% of these patients showed pelvic lymph node involvement, compared to 42.4% (56/132) in non-bulky tumors (p=0.006; odds ratio: 2.2 [95% CI: 1.3-3.6]). Patients with bulky tumors showed an increase of recurrent disease (40.2% vs. 28.0%; p=0.045). The relative risk for recurrent disease was 1.97 (95% CI: 1.3-3.0). The 5-year overall survival rate was significantly lower (67.7% [95% CI: 58.2-74.8] vs. 49.5% [95% CI: 36.8-59.1]; p=0.0015). In multivariate analysis, tumor stage, pelvic lymph node involvement and maximal tumor size were independent prognostic factors.
  
  
  CONCLUSIONS
  The results suggest that tumor size, defining bulky disease as tumors larger than 4 cm, is of prognostic impact also in FIGO stage II cervical carcinomas. A revised FIGO/TNM classification system similar to the subgrouping of stage IB CX is recommended for stage II using a cut-off value of 4 cm as discriminator: stage IIA1 and stage IIB1 for tumors with </=4 cm and IIA2 and IIB2 for tumors >4 cm (i.e. bulky disease).
authors.affiliation: Institute of Pathology, Division of Gynecologic Pathology, University Leipzig, Liebigstrasse 26, Leipzig, D-04103, Germany.
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
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010388:Pelvis; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*