Prognostic factors for relapse and pelvic lymph node metastases in early stage I adenocarcinoma of the cervix

Objectives. The aim of this study was to assess the prognostic significance of local tumor factors in predicting lymph node metastases and/or recurren ce in early adenocarcinoma of the cervix. Methods. Patients were selected from the prospective computerized cervical cancer database of the division of gynecologic oncology. All patients had r adical surgery and pelvic lymph node dissection. The study population consi sted of all patients with stage I adenocarcinoma having tumor thickness < 1 0 mm. Pathology was re-reviewed to assess histological subtype, depth, volu me, grade, and presence of capillary lymphatic space involvement. Results. The study group consisted of 68 patients, with a mean age of 40 ye ars. The median follow-up was 40 months (range 8-102 months). The median tu mor depth and volume were 2.8 mm (range 0.3-8.0 mm) and 237 mm(3) (range 0. 1-7996 mms), respectively. Twenty-two patients had tumor volumes greater th an 600 mm(3), and of these, 5 (23%) patients either had positive pelvic lym ph nodes (2) or developed recurrent disease (3) (none node positive) at a m edian time of 49 months. In comparison, 46 patients (68%) had tumor volumes of less than 600 mm(3), none of whom had positive pelvic lymph nodes or de veloped recurrence (P < 0.005). Only 1 of 20 patients with a depth of invas ion <2 mm had a tumor volume >600 mm(3) in comparison to 21 of 48 patients with deeper invasion (P < 0.002). Conclusion. The incidence of positive pelvic lymph nodes and/or recurrence in this patient population is very low. As all patients with metastatic dis ease or recurrence had tumor volumes >600 mm(3), volume of disease rather t han depth of invasion may be the single most important prognostic factor fo r the above events. However, many more patients will have to be studied to confirm this. (C) 1999 Academic Press.