Multivariate analysis of prognostic factors in patients with stage IB cervical cancer who underwent radical hysterectomy

Abstract Aim. The aim of this study was to assess the effects of prognostic factors on survival of cervical cancer patients. Methods. Data obtained from 193 patients who had been diagnosed as stage IB cervical cancer and underwent a type III radical hysterectomy and a systematic bilateral pelvic plus para-aortic lymphadenectomy between 1993 and 2007 were reviewed. Results. Twenty-three were excluded from the study as they have lost to follow-up immediately after surgery. Mean age was 53 years and median follow up was 62 months. During follow-up, recurrence was developed in 27 patients, while 26 died. In univariate analysis, the presence of metastasis in any lymph node, involvement of pelvic or para-aortic lymph nodes and adjuvant radiotherapy were significant factors in terms of disease free survival (DFS) and overall survival (OS) rate. Age and the lymphovascular space invasion were significant factors only for OS rate, whereas the depth of stromal invasion only for DFS rate. Tumor size, stage, cell type, grade, parametrial involvement, and positive surgical margins had no prognostic value. In multivariate analysis, presence of metastasis in any lymph node, pelvic lymph node involvement and age were found as independent prognostic factors for both DFS and OS. Stromal invasion was found as an independent prognostic factor only for DFS. However, no significance was found for para-aortic lymph node involvement, lymphovascular space invasion and adjuvant therapy. Conclusion. In the present study, only the lymph node status was an important factor among those determining patients with a high risk after early stage radical hysterectomy. Furthermore, it was found that age also had an important effect on survival rate as much as lymph node status had. Key words: Cervical cancer, prognostic factors. Ozet Amac. Bu calismada serviks kanserinde prognostik etkisi oldugu dusunulen faktorlerin yasam oranlari uzerindeki etkisi degerlendirildi. Yontem. 1993-2007 tarihleri arasinda evre IB serviks kanseri tanisi alan, tip III radikal histerektomi ve sistematik bilateral pelvik+para-aortik lenfadenektomi geciren 193 hastanin verileri gozden gecirildi. Bulgular. 23 hasta cerrahiden hemen sonra kontrollere gelmediginden calisma disi birakildi. Degerlendirilen 170 hastanin yas ortalamasi 53 yildi, ortanca takip suresi 62 aydi. Bu sure icinde 27 hastada nuks gelistigi ve 26 hastanin oldugu belirlendi. Univaryant analizde herhangi bir lenf nodunda metastaz varligi, pelvik veya para-aortik lenf nodu tutulumu ve adjuvan radyoterapi hastaliksiz yasam orani (DFS) ve sag kalim orani (OS) icin anlamliydi. Yas ve lenfovaskuler alan invazyonu sadece OS icin, stromal invazyon derinligiyse sadece DFS icin anlam tasimaktaydi. Tumor boyutu, evre, hucre tipi, grade , parametrial tutulum ve cerrahi sinir pozitifliginin prognostik degerinin olmadigi goruldu. Multivaryant analizde ise herhangi bir lenf nodunda metastaz varligi, pelvik lenf nodu tutulumu ve yasin, hem DFS hemde OS icin bagimsiz prognostik faktorler oldugu saptandi. Stromal invazyon sadece DFS icin bagimsiz prognostik faktordu. Buna karsin para-aortik lenf nodu tutulumu, lenfovaskuler alan invazyonu ve adjuvan radyoterapinin anlamli olmadigi belirlendi. Sonuc. Bu calismada erken evrede radikal histerektomi sonrasi yuksek-riskli grubu belirleyen faktorlerden sadece lenf nodu durumunun onemli oldugu goruldu. Bunun yani sira yasin lenf nodu durumu kadar yasam oranlari uzerine etkili oldugu saptandi. Anahtar sozcukler: Serviks kanseri, Prognostik faktorler