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[Histopathological prognostic factors in primary surgically treated cervix carcinoma].

OBJECTIVE
Standardised morphologic evaluation of radical hysterectomy specimens in primary surgically treated cervical cancer improves the selection of cases for adjuvant therapy and the precision for prognosis and may be helpful in quality control of oncologic surgery.


MATERIAL AND METHODS
Following standardised macroscopic evaluation [29] the original histologic slides of all surgically treated patients with cervical cancer were searched for tumor type, histologically proven pelvic lymph node metastases (PLM), lympho-vascular space involvement (LVSI), tumor differentiation (grading), peritumoral inflammatory response, pattern of cervical wall involvement and relative depth of invasion. The results were compared with follow up.


RESULTS
The frequency of patients up to 35th year of age was 28.8% and increased between 1979 and 1993 of about 10% (p > 0.05). Younger women represented more pT1 b1-tumors (55.6% vs. 47%), but without statistic significance. Contrary to advanced tumor stage and the presence of PLM, adenocarcinomatous histology (5.1% of all cases) was not associated with poor prognosis. Patients with pT1b-tumors of more than 4 cm largest extension (pT1 b2) showed a twice-fold frequency of PLM and pelvic recurrences. Five-year survival rate (5-Y-SR) decreased (82.7% vs. 64.9%) and more patients died of cancer (p = 0.005, each). Diffuse infiltration pattern was accompanied with higher rate of tumor recurrency and a shortening of 5-Y-SR compared with pushing borders at the front of infiltration, 38% versus 13.7% and 45.4% versus 75.2%, respectively. Similar was seen in poorly differentiated tumors (G3), compared with well differentiated (G1) carcinomas (recurrency: 15.1% vs. 27.5%, 5-Y-SR 75.7% vs. 59.3%; p < 0.05). Cases with the presence of LVSI, absence of peritumoral inflammatory response and deep cervical infiltration (> 66%) were accompanied with poor prognostic outcome.


CONCLUSIONS
In patients with primary surgically treated cervical cancer prognostic risk evaluation can be made by standardised histopathologic handling of hysterectomy specimens. Cases with early cervical cancer and high tumor load (pT1 b2), advanced staged disease (pT2 b), histologically proven PLM, LVSI, poor tumor differentiation (G3), absence of peritumoral inflammatory response and deep cervical wall infiltration are associated with poor prognostic outcome. Patients with these morphologic patterns, which can be established by clinical examination and diagnostic biopsy, represent the clientel for adjuvant or neoadjuvant therapy.