Gb. Kristensen et al., Tumor size, depth of invasion, and grading of the invasive tumor front arethe main prognostic factors in early squamous cell cervical carcinoma, GYNECOL ONC, 74(2), 1999, pp. 245-251
Objective. The objective of this study was to evaluate the prognostic signi
ficance of clinical and histopathologic factors, including a new grading sy
stem focusing on the invasive tumor front.
Method. A retrospective analysis of 125 surgically treated patients with sq
uamous cell cervical carcinoma FIGO stage IB was conducted. For each tumor,
the degree of keratinization, nuclear polymorphism, pattern of invasion, a
nd degree of lymphoid infiltration at the invasive tumor front were graded
and given scores between 1 and 4.
Results. Clinical tumor size, depth of invasion, and grading of the invasiv
e front had prognostic significance in multivariate analysis, while lymph v
ascular space involvement, lymph node status, and grade of differentiation
did not. Based on clinical tumor size, depth of invasion, and grading of th
e invasive tumor front, patients could be separated into three groups: One
group with minimal risk of recurrence (5-year disease-free survival (DFS) o
f 100%) consisting of 24% of the patients, an intermediate group with a fai
rly low risk of recurrence (5-year DFS of about 92%), and a high risk group
with a 5-year DFS of 45%. This latter group contained 26% of the patients
with 78% of all relapses occurring in the total group of patients. The inva
sive tumor front grading was reliably reproducible, with inter- and intraob
server agreement of 79 to 87% and kappa values of 0.47 to 0.66.
Conclusion. Clinical tumor size, depth of invasion, and grading of the inva
sive tumor front were the main predictors of prognosis in patients with sta
ge IB squamous cell cancer of the cervix. (C) 1999 Academic Press.