Prognostic Factors for Patients with FIGO Stage-IB Cervical Squamous Cell Carcinoma: Does the Tumor Size (≤ 4 cm or > 4 cm) Really Matter ?

摘要

OBJECTIVE To investigate the factors that can accurately predict the prognosis for patients with FIGO stage-IB cervical squamous cell carcinoma treated with radical surgery. METHODS A retrospective analysis of clinical data from 174 cases of FIGO Stage-IB cervical squamous cell carcinoma treated in our institute was conducted. RESULTS The 5-year overall disease-free survival of the patients was 79.4% and the recurrence rate was 16.7%. Seventy-five percent of the 60 patients with a tumor > 4 cm and 28.1% of the 114 patients with a tumor ≤ 4 cm received preoperative radiotherapy, resuting in a significant difference between the two groups (P < 0.001). The 5-year disease-free survival rate for the groups with a tumor ≤ 4 cm without and with preoperative radiotherapy, and with a tumor > 4 cm without and with preoperative radiation therapy were 80.5%, 85.2%, 69.3% and 77.1%, respectively. There was no significant difference between any of the groups (P > 0.05). A univariate analysis showed that pelvic node metastasis, a positive parametrial surgical margin and postoperative adjuvant therapy were all significantly correlated with the 5-year disease-free survivals (P < 0.05). Multivariate analysis revealed that pelvic node metastasis (P = 0.004) and a positive parametrial surgical margin (P = 0.040) were independent factors that influenced the prognosis. The 5-year disease-free survivals for the cases with a tumor ≤ 4 cm and > 4 cm were 57.4% and 44.7% respectively in the high-risk group (patients with pelvic lymphatic metastasis and/or positive parametrial surgical margin) (P = 0.575) and the recurrence ratio was 7/18 and 6/14 for the cases of the two tumor sizes in the same risk group. There was no significant difference between the two groups (P = 0.821). The 5-year disease-free survivals for the cases with a tumor ≤ 4 cm and > 4 cm were 86.5% and 82.9% respectively in the low-risk group (patients without pelvic lymph-node metastasis and/or positive parametrial surgical margin), respectively (P > 0.05) and the recurrence ratio was 9/95 and 7/47 for the cases of the two tumor sizes in the same risk group. There was no significant difference between the two groups (P > 0.05). CONCLUSIONS For FIGO Stage-IB cervical squamous cell carcinoma patients with radical surgery as the major means of treatment, the features of pelvic lymph-node metastasis and a positive parametrial surgical margin are independent factors that influence the prognosis. The tumor size can not be used as a criterion for predicting the prognosis.