Prognostic relevance of low-grade versus high-grade FIGO IB1 squamous cell uterine cervical carcinomas
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Tumor grade is one of the more controversial factors with limited prognostic information in squamous cell carcinomas (SCC) of the uterine cervix.
Histologic slides of 233 surgically treated cervical SCC (FIGO IB1) were re-examined regarding the prognostic impact of the WHO-based grading system, using the different degree of keratinization, categorizing the tumors in G1, G2 and G3 (conventional tumor grade).
45.1% presented with well-differentiated tumors (G1), 29.2% with moderate (G2) and 25.8% with poor differentiation (G3). Tumor grade significantly correlated with decreased recurrence-free and overall survival. However, detailed analyses between G1- and G2-tumors failed to show any correlation with either recurrence-free or overall survival. G1- and G2-tumors were therefore merged into low-grade tumors and were compared to the high-grade group (G3-tumors). This binary conventional grading system showed an improved 5-years recurrence-free (low-grade: 90.2% vs. high-grade: 71.6%; p = 0.001) and overall survival rates (low-grade: 89.9% vs. high-grade: 71.1%; p = 0.001) for low-grade tumors. On multivariate analysis adjusted for lymph node metastasis, high-grade tumors represented a hazard ratio of 2.4 (95% CI 1.3–4.7) for reduced recurrence-free and 2.4 (95% CI 1.2–4.6) for overall survival. High-grade tumors showed a significantly higher risk for pelvic lymph node involvement [OR 2.7 (95% CI 1.4–5.5); p = 0.003]. The traditional three-tiered grading system failed to predict pelvic lymph node metastases.
A binary grading model for the conventional tumor grade (based on the degree of keratinization) in SCC of the uterine cervix may allow a better prognostic discrimination than the traditionally used three-tiered system.
KeywordsCervix Cancer Prognosis Grading Histopathology Treatment Squamous cell Survival
The authors declare that there was no funding of the study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- Brierley JD, Gospodarowicz MK, Wittekind C (2017) Cervix uteri. TNM classification of malignant tumors. Wiley-Blackwell, Chichester, pp 166–170Google Scholar
- Broders AC (1926) Carcinoma grading and practical application. Arch Pathol 2:376–381Google Scholar
- Horn LC, Hommel N, Roschlau U, Bilek K, Hentschel B, Einenkel J (2012) Peritumoral stromal remodeling, pattern of invasion and expression of c-met/HGF in advanced squamous cell carcinoma of the cervix uteri, FIGO stages III and IV. Eur J Obstet Gynecol Reprod Biol 163(1):76–80PubMedCrossRefGoogle Scholar
- ICCR (2017) http://www.iccr-cancer.org/datasets/datasets-under-consultation/datasets-for-comment/iccr-cervix-bookmarked-guide-1st-edition-v0-5-with. Accessed 10 Dec 2018
- Piura B, Rabinovich A, Friger M (2006) Surgical pathologic factors in patients with early-stage cervical carcinoma treated with radical hysterectomy and pelvic lymph node dissection: association with administration of adjuvant radiotherapy and effect on survival. Eur J Gynaecol Oncol 27(6):573–578PubMedGoogle Scholar
- Stock RJ, Zaino R, Bundy BN, Askin FB, Woodward J, Fetter B, Paulson JA, DiSaia PJ, Stehman FB (1994) Evaluation and comparison of histopathologic grading systems of epithelial carcinoma of the uterine cervix: Gynecologic Oncology Group studies. Int J Gynecol Pathol 13(2):99–108PubMedCrossRefGoogle Scholar
- Stoler M, Bergeron C, Colgan TJ, Ferency AS, Herrington CS, Kim KR, Loening T, Schneider A, Sherman ME, Wilbur DC, Wright T (2014) Squamous cell tumors of the uterine cervix and its precursors. In: Kurman RJ, Carcangiou ML, Herrington S, Young RH (eds) WHO classification of tumours of female reproductive organs. IARC Press, Lyon, pp 172–182Google Scholar
- Taira T, Ishii G, Nagai K, Yoh K, Takahashi Y, Matsumura Y, Kojima M, Ohmatsu H, Goto K, Niho S, Takashima H, Inoue H, Ohe Y, Ochiai A (2012) Characterization of the immunophenotype of the tumor budding and its prognostic implications in squamous cell carcinoma of the lung. Lung Cancer 76(3):423–430PubMedCrossRefGoogle Scholar
- Takeda N, Sakuragi N, Takeda M, Okamoto K, Kuwabara M, Negishi H, Oikawa M, Yamamoto R, Yamada H, Fujimoto S (2002) Multivariate analysis of histopathologic prognostic factors for invasive cervical cancer treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy. Acta Obstet Gynecol Scand 81(12):1144–1151PubMedCrossRefGoogle Scholar
- Travis W, Brambilla E, Muller-Hermelink H et al (2004) World Health Organization classification of tumours pathology and genetics tumours of the lung, pleura, thymus, and heart. IARC Press, LyonGoogle Scholar
- Wells M, Östör AG, Crum CP, Franceschi S, Tommasino M, Nesland JM, Goodman AK, Sankaranarayanan R, Hanselaar AG, Albores-Saavedra J (2003) Epithelial Tumors of the uterine cervix. In: Tavassoli FA, Devilee P (eds) Tumors of the breast and female genital organs. IARC Press, Lyon, pp 261–272Google Scholar