title: Menopausal status: a possible predictive factor for recurrence in women with cancer of the uterine cervix without pelvic lymph node metastasis.
abstract: OBJECTIVE
  To evaluate risk factors for recurrence of carcinoma of the uterine cervix among women who had undergone radical hysterectomy without pelvic lymph node metastasis, while taking into consideration not only the classical histopathological factors but also sociodemographic, clinical and treatment-related factors.
  
  
  METHODS
  This was an exploratory analysis on 233 women with carcinoma of the uterine cervix (stages IB and IIA) who were treated by means of radical hysterectomy and pelvic lymphadenectomy, with free surgical margins and without lymph node metastases on conventional histopathological examination. Women with histologically normal lymph nodes but with micrometastases in the immunohistochemical analysis (AE1/AE3) were excluded. Disease-free survival for sociodemographic, clinical and histopathological variables was calculated using the Kaplan-Meier method. The Cox proportional hazards model was used to identify the independent risk factors for recurrence.
  
  
  RESULTS
  Twenty-seven recurrences were recorded (11.6%), of which 18 were pelvic, four were distant, four were pelvic+distant and one was of unknown location. The five-year disease-free survival rate among the study population was 88.4%. The independent risk factors for recurrence in the multivariate analysis were: postmenopausal status (HR 14.1; 95% CI: 3.7-53.6; P<0.001), absence of or slight inflammatory reaction (HR 7.9; 95% CI: 1.7-36.5; P=0.008) and invasion of the deepest third of the cervix (HR 6.1; 95% CI: 1.3-29.1; P=0.021). Postoperative radiotherapy was identified as a protective factor against recurrence (HR 0.02; 95% CI: 0.001-0.25; P=0.003).
  
  
  CONCLUSIONS
  Postmenopausal status is a possible independent risk factor for recurrence even when adjusted for classical prognostic factors (such as tumour size, depth of tumour invasion, capillary embolisation) and treatment-related factors (period of treatment and postoperative radiotherapy status).
authors.affiliation: Department of Gynaecological Oncology, Barretos Cancer Hospital, Brazil. mdfregnani@terra.com.br
authors.forename: José H T G
authors.initials: JH
authors.lastname: Fregnani
authors.forename: Maria R D O
authors.initials: MR
authors.lastname: Latorre
authors.forename: Pablo R
authors.initials: PR
authors.lastname: Novik
authors.forename: Ademar
authors.initials: A
authors.lastname: Lopes
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Soares
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014594:Uterine Neoplasms / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery; D055815:Young Adult