title: Tumor invasion depth is a useful pathologic assessment for predicting outcomes in cervical squamous cell carcinoma after neoadjuvant radiotherapy.
abstract: BACKGROUND
  To evaluate whether tumor invasion depth can be a reliable and easily applicable pathologic assessment strategy to predict outcomes using surgically resected cervical squamous cell carcinoma specimens from patients who have received neoadjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT).
  
  
  METHODS
  We included 173 patients with cervical squamous cell carcinoma who received neoadjuvant CCRT (n = 125) or RT (n = 48) and underwent subsequent radical hysterectomy. Data for the pre-operative clinical International Federation of Gynecology and Obstetrics (FIGO) stage, post-operative pathologic FIGO stage, World Health Organization (WHO) double diameter measurement evaluation, response evaluation criteria in solid tumors (RECIST 1.1) criteria, tumor necrosis rate (TNR), and tumor regression grade (TRG) were investigated to identify correlations with outcomes related to distant metastasis and survival. The tumor invasion depth (TID) and the tumor invasion depth with cytokeratin immunostaining correction (TIDC) at the cervical internal surface were measured to assess their relations to patients' outcomes.
  
  
  RESULTS
  Based on measurements taken via transvaginal ultrasound, the pre-operative clinical and post-operative pathologic FIGO staging as well as the WHO double diameter measurement evaluation and RECIST 1.1 criteria were predictive of distant metastasis and survival-related outcomes. Also, lymph node involvement was found to be an independent prognostic factor for recurrence and distant metastasis. Finally, univariate analysis showed both the TID and TIDC were highly related to distant metastasis, overall survival, and progression-free survival, irrespective of the clinical stage of carcinomas.
  
  
  CONCLUSIONS
  The TID or TIDC measured at the cervical internal surface is a useful and easily applied pathologic prognostic factor for distant metastasis and survival outcomes in patients with cervical squamous cell carcinoma treated with neoadjuvant RT or CCRT.
authors.affiliation: State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Lv
authors.affiliation: Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China.
authors.forename: Ning
authors.initials: N
authors.lastname: Wang
authors.affiliation: State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China.
authors.forename: Yixiong
authors.initials: Y
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China.
authors.forename: Xia
authors.initials: X
authors.lastname: Li
authors.affiliation: State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China.
authors.forename: Linni
authors.initials: L
authors.lastname: Fan
authors.affiliation: State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China.
authors.forename: Mingyang
authors.initials: M
authors.lastname: Li
authors.affiliation: State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China.
authors.forename: Lu
authors.initials: L
authors.lastname: Wang
authors.affiliation: State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China.
authors.forename: Zhou
authors.initials: Z
authors.lastname: Yu
authors.affiliation: State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China.
authors.forename: Qingguo
authors.initials: Q
authors.lastname: Yan
authors.affiliation: State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Guo
authors.affiliation: State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China.
authors.forename: Shuangping
authors.initials: S
authors.lastname: Guo
authors.affiliation: Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China. weilichun@fmmu.edu.cn.
authors.forename: Lichun
authors.initials: L
authors.lastname: Wei
authors.affiliation: Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China. mshi82@fmmu.edu.cn.
authors.forename: Mei
authors.initials: M
authors.lastname: Shi
authors.affiliation: State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China. zhwang@fmmu.edu.cn.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging / Q000379:methods; D011379:Prognosis; D002583:Uterine Cervical Neoplasms / Q000473:pathology*