Intensity of cervical inflammatory reaction as a risk factor for recurrence of carcinoma of the uterine cervix in stages IB and IIA.
OBJECTIVE
Inflammatory reaction intensity has been indicated as a possible recurrence risk factor in carcinoma of the uterine cervix. Some authors observed greater risk with weak inflammatory reaction, while others described the opposite. This study aimed to evaluate risk factors for initial-stage uterine cervix carcinoma recurrence (IB and IIA), considering inflammatory reaction intensity.


METHODS
Retrospective cohort at Hospital do Câncer A. C. Camargo.


METHODS
289 patients with diagnosed uterine cervix carcinoma (stages IB and IIA) who underwent radical surgery between 1980 and 1999 were studied. Data were collected from medical records. Histological sections from tumors and lymph nodes could be reviewed in 247 cases. Five-year disease-free survival rates were calculated using the Kaplan-Meier method and curves were compared using the log-rank test. Cox's proportional-hazards model was used for multivariate analysis. Recurrence risk was estimated using hazard ratios (HR).


RESULTS
Forty-three recurrences were found. Multivariate analysis identified the following independent recurrence risk factors: number of metastatic pelvic lymph nodes (one lymph node: HR = 3.3 [1.3-8.3]; two or three: HR = 5.3 [1.5-18.6]; four or more: HR = 7.6 [1.7-33.2]), tumor invasion depth (deepest third: HR = 2.1 [1.1-4.1]) and inflammatory reaction intensity in the uterine cervix (absent or slight: HR = 2.5 [1.1-5.7]).


CONCLUSIONS
This study identified that absent or slight inflammatory reaction was an independent risk factor for recurrence. The other risk factors were the number of metastatic pelvic lymph nodes and invasion of the deepest third of the uterine cervix.
Fregnani
José Humberto Tavares Guerreiro
JH
Treatment and Research Center, Hospital do Câncer A. C. Camargo, São Paulo, Brazil. mdfregnani@terra.com.br
Soares
Fernando Augusto
FA
Novik
Pablo Roberto
PR
Lopes
Ademar
A
Latorre
Maria do Rosário Dias de Oliveira
Mdo R
D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002277:Carcinoma / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D002584:Cervix Uteri / Q000473:pathology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007249:Inflammation / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D010388:Pelvis; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery