AN ANALYSIS OF CELL-TYPE IN PATIENTS WITH SURGICALLY STAGED STAGE IB CARCINOMA OF THE CERVIX - A GYNECOLOGIC-ONCOLOGY-GROUP STUDY

The influence of cell type on recurrence-free interval (RFI) and survi val after radical hysterectomy for patients with Stage IB carcinoma of the cervix was investigated. Patients with Stage IB carcinoma of the cervix (>3-mm invasion) underwent a radical hysterectomy and pelvic ly mphadenectomy. Patients with involved paraaortic nodes or gross extrac ervical disease were excluded. Of 813 evaluable patients, 645 had squa mous, 104 with adenocarcinoma, and 64 had adenosquamous cell type. The time to failure and the following clinical/pathologic characteristics were compared among the three cell types: age, Gynecologic Oncology G roup performance status (PS), gross versus occult tumor, histologic gr ade, depth of invasion, node status, uterine extension, parametrial ex tension, surgical margins, and capillary-lymphatic space (CLS) involve ment. A Cox proportional hazards model was used to compare the patient s with adenosquamous and adenocarcinoma to those with squamous while a djusting for prognostic factors. The median age was 40 years (range, 2 1-87). Pelvic nodes were involved in 119 (15%) of patients. There were no significant differences between cell types in distributions of the following factors: age, PS, positive nodes, depth of invasion, uterin e extension, surgical margins, or parametrial extension. There were st atistically significant differences between cell types with regards to grade (P <0.001), gross versus occult primary status (P=0.016), and C LS involvement (P=0.005). There was no statistically significant diffe rence detected between cell types in crude comparisons of RFI (P=0.29) ; however, there was a difference in survival (P=0.02) with shorter su rvival seen in the adenosquamous cell type. After adjusting for CLS in volvement, PS, depth of invasion, and clinical tumor size, survival re mained worse for patients with adenosquamous primaries when compared t o squamous carcinoma (P=0.02) and adenocarcinoma (P=0.007). In conclus ion, no statistically significant differences were seen in RFI among c ell types; however, in patients with Stage I carcinoma of the cervix o verall survival after radical hysterectomy may be slightly worse for t hose with adenosquamous cell type. (C) 1996 Academic Press, Inc.