Skip to main content
SpringerLink
Log in

Prognostic significance of keratinization in squamous cell cancer of uterine cervix: a population based study

  • Original Article
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To determine the influence of keratinization on prognosis in squamous cell cancer (SCC) of the uterine cervix.

Methods

Patients with keratinized squamous cell carcinoma (KSCC) and non-keratinized squamous cell carcinoma (NKSCC) of the cervix were identified from the Limited Use SEER database from 1988 to 2004. A subgroup of patients who did not have radiation or surgery formed the basis to study the natural history of the disease. Data were analyzed using Pearson Chi-square, Student’s T tests. Kaplan–Meier and Cox Regression Proportional Hazards survival analysis was conducted in SPSS and SEER-Stat software.

Results

The KSCC group had 3,102 and the NKSCC had 3,751 patients with mean age being 51 and 49 years, respectively (P = 0.001). In general, patients with KSCC were more likely to have advanced stage (FIGO III and IV) disease while patients with NKSCC were more likely to have poorly differentiated neoplasms (P < 0.001). The prevalence of lymph node metastasis remained similar in both histology types (P > 0.05). Overall, the 5-year survival in KSCC was 63.4% as compared to 65.3% in the NKSCC group (P = 0.04). Patients treated by surgery had no difference in survival; however, patients treated by radiation had a median survival in KSCC of 33 months (n = 928, 95% CI 27.7–38.3) as compared to 38 months (n = 1,140, 95% CI 32.1–43.8) in NKSCC (P = 0.03).

A total of 165 KSCC and 147 NKSCC patients did not receive treatment. Within this subgroup, the median survival was 10 months (95% CI 5.93–14.07) as compared to 28 months (95% CI 17.9–38.0; P = 0.001) respectively for the two cohorts. In multivariate analysis stage, treatment status, nodal metastasis and keratinization were independent predictors of survival (P < 0.05).

Conclusion

This is the largest study reporting on the prognostic importance of keratinization in SCC. KSCC may be less radiosensitive and associated with shorter overall survival. Also, in the natural history of the SCC, keratinization signifies striking reduction in survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Parkin DM, Pisani P, Ferlay J (1999) Global cancer statistics. CA Cancer J Clin 49(1):33–64

    Article  PubMed  CAS  Google Scholar 

  2. Thomas G (2006) Cervical cancer: treatment challenges in the developing world. Radiother Oncol 79:139–141

    Article  PubMed  Google Scholar 

  3. Poulsen HE, Taylor CW, Sobin LH (1975) Histological typing of female genital-tract tumours. World Health Organization, Geneva, pp 55–59

    Google Scholar 

  4. Pagnini CA, Della Palma P, De Laurentiis G (1980) Malignancy grading in squamous carcinoma of uterine cervix treated by surgery. Br J Cancer 41:415–421

    PubMed  CAS  Google Scholar 

  5. Larsson G, Alm P, Gullberg B, Grundsell H (1983) Prognostic factors in early invasive carcinoma of the uterine cervix. A clinical, histopathologic, and statistical analysis of 343 cases. Am J Obstet Gynecol 146:145–153

    PubMed  CAS  Google Scholar 

  6. Inoue T (1984) Prognostic significance of the depth of invasion relating to nodal metastases, parametrial extension, and cell types. A study of 628 cases with Stage IB, IIA, and IIB cervical carcinoma. Cancer 54:3035–3042

    Article  PubMed  CAS  Google Scholar 

  7. Wentz WB, Reagan JW (1959) Survival in cervical cancer with respect to cell type. Cancer 12:384–388

    Article  PubMed  CAS  Google Scholar 

  8. Beecham JB, Halvorsen T, Kolbenstvedt A (1978) Histologic classification, lymph node metastases, and patient survival in stage IB cervical carcinoma: an analysis of 245 uniformly treated cases. Gynecol Oncol 6:95–105

    Article  PubMed  CAS  Google Scholar 

  9. Randall ME, Constable WC, Hahn SS, Kim JA, Mills SE (1988) Results of the radiotherapeutic management of carcinoma of the cervix with emphasis on the influence of histologic classification. Cancer 62:48–53

    Article  PubMed  CAS  Google Scholar 

  10. Crissman JD, Makuch R, Budhraja M (1985) Histopathologic grading of squamous cell carcinoma of the uterine cervix. An evaluation of 70 stage Ib patients. Cancer 55:1590–1596

    Article  PubMed  CAS  Google Scholar 

  11. Barber BR, Sommers SC, Rotterdam H, Kwon T (1978) Vascular invasion as a prognostic factor in stage IB cancer of the cervix. Obstet Gynecol 52:343–348

    PubMed  CAS  Google Scholar 

  12. NCI (2007) Surveillance E, and End Results (SEER) Program (http://www.seer.cancer.gov) SEER*Stat Database: Incidence—SEER 17 Regs Limited-Use, November 2006 Sub (1973–2004 varying)—Linked To County Attributes—Total US, 1969–2004 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, Released April 2007, based on the November 2006 submission

  13. Reagan JW, Hamonic MJ, Wentz WB (1957) Analytical study of the cells in cervical squamous-cell cancer. Lab Invest 6:241–250

    PubMed  CAS  Google Scholar 

  14. Bangle R Jr, Berger M, Levin M (1963) Variations in the morphogenesis of squamous carcinoma of the cervix. Cancer 16:1151–1159

    Article  PubMed  Google Scholar 

  15. Ngan HY, Obradovic D, Krauer F (1988) Cancer of the cervix stage Ib and IIa: survival related to treatment and histopathological risk factors. Eur J Surg Oncol 14:203–208

    PubMed  CAS  Google Scholar 

  16. Wentz WB, Lewis GC Jr (1965) Correlation of histologic morphology and survival in cervical cancer following radiation therapy. Obstet Gynecol 26:228–232

    PubMed  CAS  Google Scholar 

  17. dalla Palma P, Arslan Pagnini C, de Laurentiis G (1980) Prognostic significance of the cyto-histological classification of infiltrating cervical epidermoid carcinoma. Tumori 66:183–190

    PubMed  CAS  Google Scholar 

  18. Gunderson LL, Weems WS, Herbertson RM, Plenk HP (1974) Correlation of histopathology with clinical results following radiation therapy for carcinoma of the cervix. Am J Roentgenol Radium Ther Nucl Med 120:74–87

    PubMed  CAS  Google Scholar 

  19. Johansson O, Johnsson JE, Lindberg JG, Sydsjo A (1976) Prognosis, recurrences and metastases correlated to histologic cell type in carcinoma of the uterine cervix. Acta Obstet Gynecol Scand 55:255–259

    Article  PubMed  CAS  Google Scholar 

  20. NCI. National Cancer Institute: Data quality. In; 2007

  21. Harlan LC, Hankey BF (2003) The surveillance, epidemiology, and end-results program database as a resource for conducting descriptive epidemiologic and clinical studies. J Clin Oncol 21:2232–2233

    Article  PubMed  Google Scholar 

  22. Virnig BA, Warren JL, Cooper GS, Klabunde CN, Schussler N, Freeman J (2002) Studying radiation therapy using SEER-Medicare-linked data. Med Care l, 40: IV-49-54

  23. Cooper GS, Virnig B, Klabunde CN, Schussler N, Freeman J, Warren JL (2002) Use of SEER-Medicare data for measuring cancer surgery. Med Care l, 40: IV-43-8

Download references

Conflict of interest statement

All the authors declare that there are no conflicts of interest to be disclosed.

Author information

Authors and Affiliations

  1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, USA

    Sanjeev Kumar, Jay P. Shah, Christopher S. Bryant, Anthony N. Imudia, John M. Malone Jr & Robert T. Morris

  2. Department of Pathology, School of Medicine, Wayne State University, Detroit, MI, USA

    Rouba Ali-Fehmi

  3. Karmanos Cancer Institute, Detroit, MI, USA

    Sanjeev Kumar, Jay P. Shah, Christopher S. Bryant, Anthony N. Imudia, Rouba Ali-Fehmi, John M. Malone Jr & Robert T. Morris

  4. Department of Obstetrics and Gynecology, Hutzel Women’s Hospital, Wayne State University, 3990 John R, 7 Brush North, Detroit, MI, 48201, USA

    Sanjeev Kumar

Authors
  1. Sanjeev Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jay P. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christopher S. Bryant
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anthony N. Imudia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rouba Ali-Fehmi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. John M. Malone Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Robert T. Morris
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sanjeev Kumar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kumar, S., Shah, J.P., Bryant, C.S. et al. Prognostic significance of keratinization in squamous cell cancer of uterine cervix: a population based study. Arch Gynecol Obstet 280, 25–32 (2009). https://doi.org/10.1007/s00404-008-0851-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-008-0851-9

Keywords

Search

Navigation