PROGNOSTIC FACTORS AND RELAPSE PATTERNS IN EARLY-STAGE CERVICAL-CARCINOMA AFTER BRACHYTHERAPY AND RADICAL HYSTERECTOMY

Patients with cervical carcinoma FIGO stage IB and IIA (n = 167) treat ed with brachytherapy, radical hysterectomy, and pelvic lymphadenectom y at the University Hospital of Uppsala were evaluated, and a multivar iate analysis was performed to reveal clinical and histopathological v ariables of predictive value of recurrence. The 5-year survival rate w as 90%. Nineteen patients developed recurrent disease (11%), 15 of who m died. Patient age, clinical stage, type, and histologic grade of tum or did not indicate an increased risk of recurrence. However, multipar ity (3 children or more; relative risk, RR = 4.6), lymph node metastas es (RR = 6.4), tumor size (RR = 5.1), and residual carcinoma in the hy sterectomy specimen (RR = 3.4) were important predictive indicators of recurrence. The median interval from initial treatment to the diagnos is of recurrence was 15 months. The majority of recurrences occurred d uring the first 2 years after treatment (74%) and most of them had sym ptoms (84%). Only three patients with recurrence were diagnosed within our surveillance program. The data suggest that surveillance for recu rrence can be made more cost efficient with a more individualized foll ow-up during the first 2 years after treatment, concentrating on the p atients with high-risk factors such as large tumors, residual carcinom a after irradiation therapy, and/or lymph node metastases. (C) 1994 Ac ademic Press, Inc.