title: Tumor-free distance from outermost layer of cervix is of prognostic value in surgically treated cervical cancer patients: a multicenter study.
abstract: OBJECTIVE
  This study aimed at determining if tumor-free distance (TFD) from outermost layer of cervix predicts surgicopathologic factors and outcome in surgically treated cervical cancer patients.
  
  
  METHODS
  One hundred sixteen surgically treated cervical squamous cell carcinomas between 1991 and 2010 with FIGO stage IB/2A were identified and re-evaluated histologically regarding the TFD. TFD was defined as the distance between outermost layer of cervix and deepest cervical stromal invasion. Depth of invasion (DOI) and TFD were expressed as continuous variables and compared with traditional surgicopathologic variables and survival to determine their prognostic significance.
  
  
  RESULTS
  The mean DOI was 10.3 mm and the mean TFD was 4.2 mm. The most common stage was IB1 (60 patients, 51.7 %). The mean number of removed pelvic lymph nodes was 32.2 (median 30; range 8-78). Positive pelvic lymph nodes were found in 27 (23 %) of the patients. Sixty-eight patients had lymphovascular space involvement (LVSI). Sixty-eight patients (59 %) received postoperative radiotherapy where the following items were present: tumor diameter >4 cm, positive lymph nodes, LVSI and positive surgical margins. With the median follow-up of 53 months (3-219 months); 14 patients had local and 13 patients had distant metastases (5 of the patients had both at the time of recurrence). With logistic regression analysis, TFD was a predictor of pelvic lymph involvement (p = 0.028) and LVSI (p = 0.008) while DOI was a predictor of LVSI (p = 0.044). In Cox regression analysis, increased TFD was associated with improved disease-free survival (DFS) (p = 0.007). DFS curves (for TFD cut off value 2.5 mm) according to Kaplan-Meier were found to be statistically significant (log rank test = 0.002).
  
  
  CONCLUSIONS
  The results indicate that TFD is predictive of pelvic lymph node involvement, LVSI and patient outcome in surgically treated cervical cancer patients. However, prospective measurement of TFD is still necessary to determine its value in clinical practice.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Bahadir
authors.initials: B
authors.lastname: Saatli
authors.forename: Safak
authors.initials: S
authors.lastname: Olgan
authors.forename: Iknur B
authors.initials: IB
authors.lastname: Gorken
authors.forename: Turhan
authors.initials: T
authors.lastname: Uslu
authors.forename: Ugur
authors.initials: U
authors.lastname: Saygili
authors.forename: Nilgun
authors.initials: N
authors.lastname: Dicle
authors.forename: Basak
authors.initials: B
authors.lastname: Cingillioglu
authors.forename: Derya
authors.initials: D
authors.lastname: Gumurdulu
authors.forename: Ahmet Baris
authors.initials: AB
authors.lastname: Guzel
authors.forename: Meral
authors.initials: M
authors.lastname: Koyuncuoglu
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery; D002584:Cervix Uteri / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery