Cervix Uteri Carcinoma

  • A. Fyles
  • P. Kirkbride
Part of the UICC International Union Against Cancer / Union Internationale Contre le Cancer book series (UICCI)

Abstract

Carcinoma of the cervix accounts for approximately one fifth of all gynecologic cancers and 2% of all malignancies in women. Numerous prognostic factors have been studied in patients with cervical carcinoma, using both univariate and multivariate analyses. Differences in end points of analysis, whether survival (disease-free or overall), relapse-free rate or local control rate, make comparisons of such studies difficult. Stage, histologic type and histologic grade are the commonly considered factors and have recently been joined by biologic factors including DNA ploidy, S-phase fraction and oncogene expression. Not all factors are relevant to all patients; for example, depth of tumor invasion and presence of vascular space invasion may only be reliably determined in patients treated with surgery, whereas hemoglobin level is important in patients treated with radiation. This review will concentrate largely on those factors identified using multivariate techniques, such as log rank or Cox regression analysis, in order to account for interactions between various factors and will present estimates such as hazard ratios, where available, in order to indicate the strengths of individual variables.

Keywords

Toxicity Estrogen Adenocarcinoma Anemia Fractionation 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Alvarez RD, Soong SJ, Kinney WK et al (1989) Identification of prognostic factors and risk groups in patients found to have nodal metastasis at the time of radical hysterectomy for early- stage squamous carcinoma of the cervix. Gynecol Oncol 35: 130–135PubMedCrossRefGoogle Scholar
  2. 2.
    Avall-Lundqvist EH, Sjovall K, Nilsson BR et al (1992) Prognostic significance of pretreatment serum levels of squamous cell carcinoma antigen and CA 125 in cervical carcinoma. Eur J Cancer 28A: 1695–1702CrossRefGoogle Scholar
  3. 3.
    Benstead K, Cowie VJ, Blair V et al (1986) Stage III carcinoma of cervix. The importance of increasing age and extent of parametrial infiltration. Radiother Oncol 5: 271–276PubMedCrossRefGoogle Scholar
  4. 4.
    Connor JP, Miller DS, Bauer KD et al (1993) Flow cytometric evaluation of early invasive cervical cancer. Obstet Gynecol 81: 367–371PubMedGoogle Scholar
  5. 5.
    DeBritton RC, Hildesheim A, De LS et al (1993) Human papillomaviruses and other influences on survival from cervical cancer in Panama. Obstet Gynecol 81: 19–24PubMedGoogle Scholar
  6. 6.
    Delgado G, Bundy B, Zaino R et al (1990) Prospective surgical-pathologic study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol 38: 352–357PubMedCrossRefGoogle Scholar
  7. 7.
    Franco EL (1992) Prognostic value of human papillomavirus in the survival of cervical cancer patients: an overview of the evidence. Cancer Epidemiol Biomarkers Prev 1: 499–504PubMedGoogle Scholar
  8. 8.
    Fyles A, Keane TJ, Barton M Et Al (1992) The effect of treatment duration in the local control of cervix cancer. Radiother Oncol 25: 273–279PubMedCrossRefGoogle Scholar
  9. 9.
    Fyles A, Kirkbride P, Levin W Et Al (1995) Prognostic factors for survival in patients with cervix cancer treated by radiation therapy: results of a multiple regression analysis. Radiother Oncol (in press)Google Scholar
  10. 10.
    Girinski T, Pejovic-Lenfant MH, Bourhis J et al (1989) Prognostic value of hemoglobin concentrations and blood transfusions in advanced carcinoma of the cervix treated by radiation therapy: results of a retrospective study of 386 patients. Int J Radiat Oncol Biol Phys 16: 37–42PubMedCrossRefGoogle Scholar
  11. 11.
    Girinsky T, Lubin R, Pignon JP et al (1992) Predictive value of in vitro radiosensitivity parameters in head and neck cancers and cervical carcinomas: preliminary correlations with local control and overall survival. Int J Radiat Oncol Biol Phys 25: 3–7Google Scholar
  12. 12.
    Gonzalez D, Ketting B W, van Bunningen B et al (1989) Carcinoma of the uterine cervix stage IB and IIA: results of postoperative irradiation in patients with microscopic infiltration in the parametrium and/or lymph node metastasis. Int J Radiat Oncol Biol Phys 16: 389–395CrossRefGoogle Scholar
  13. 13.
    Hale RJ, Buckley CH, Fox H et al (1992) Prognostic value of c-erbB-2 expression in uterine cervical carcinoma. J Clin Pathol 45: 594–596PubMedCrossRefGoogle Scholar
  14. 14.
    Hale RJ, Buckley CH, Gullick WJ et al (1993) Prognostic value of epidermal growth factor receptor expression in cervical carcinoma. J Clin Pathol 46: 149–153PubMedCrossRefGoogle Scholar
  15. 15.
    Hermanek P, Sobin LH (eds) (1992) UICC TNM classification of malignant tumours 4th edn, 2nd revision 1992. Springer, Berlin Heidelberg New YorkGoogle Scholar
  16. 16.
    Hernandez E, Lavine M, Dunton CJ et al (1992) Poor prognosis associated with thrombocytosis in patients with cervical cancer. Cancer 69: 2975–2977PubMedCrossRefGoogle Scholar
  17. 17.
    Higgins GD, Davy M, Roder D et al (1991) Increased age and mortality associated with cervical carcinomas negative for human papillomavirus RNA. Lancet 338: 910–913PubMedCrossRefGoogle Scholar
  18. 18.
    Höckel M, Knoop C, Schienger K et al (1993) Intratumoral p02 predicts survival in advanced cancer of the uterine cervix. Radiother Oncol 26: 45–50PubMedCrossRefGoogle Scholar
  19. 19.
    Ireland D, Monaghan JM (1985) A critical evaluation of three methods of studying cell proliferation in human cervical epithelium. Obstet Gynecol 65: 227–234PubMedGoogle Scholar
  20. 20.
    Jakobsen A, Bichel P, Vaeth M (1985) New prognostic factors in squamous cell carcinoma of cervix uteri. Am J Clin Oncol 8: 39–43PubMedCrossRefGoogle Scholar
  21. 21.
    Johnson DW, Cox RS, Billingham G et al (1983) Survival, prognostic factors, and relapse patterns in uterine cervical carcinoma. Am J Clin Oncol 6: 407–415PubMedCrossRefGoogle Scholar
  22. 22.
    Kamura T, Tsukamoto N, Tsuruchi N et al (1992) Multivariate analysis of the histopathologic prognostic factors of cervical cancer in patients undergoing radical hysterectomy. Cancer 69: 181–186PubMedCrossRefGoogle Scholar
  23. 23.
    Kapp DS, Fischer D, Gutierrez E et al (1983) Pretreatment prognostic factors in carcinoma of the uterine cervix: a multivariable analysis of the effect of age, stage, histology and blood counts on survival. Int J Radiat Oncol Biol Phys 9: 445–455PubMedCrossRefGoogle Scholar
  24. 24.
    Kenter GG, Cornelisse CJ, Aartsen EJ et al (1990) DNA ploidy level as prognostic factor in low stage carcinoma of the uterine cervix. Gynecol Oncol 39: 181–185PubMedCrossRefGoogle Scholar
  25. 25.
    Lanciano RM, Pajak TF, Martz M et al (1993) The influence of treatment time on outcome for squamous cell cancer of the uterine cervix treated with radiation: a Patterns of Care study. Int J Radiat Oncol Biol Phys 25: 391–397PubMedCrossRefGoogle Scholar
  26. 26.
    Lanciano RM, Won M, Coia LR et al (1991) Pretreatment and treatment factors associated with improved outcome in squamous cell carcinoma of the uterine cervix: a final report of the 1973 and 1978 Patterns of Care studies. Int J Radiat Oncol Biol Phys 20: 667–676PubMedCrossRefGoogle Scholar
  27. 27.
    Meanwell CA, Kelly KA, Wilson S et al (1988) Young age as a prognostic factor in cervical cancer: analysis of population based data from 10,022 cases. Br Med J (Clin Res Ed) 296: 386–391CrossRefGoogle Scholar
  28. 28.
    Oka K, Hoshi T, Arai T (1992) Prognostic significance of the PC 10 index as a prospective assay for cervical cancer treated with radiation therapy alone. Cancer 70: 1545–1550PubMedCrossRefGoogle Scholar
  29. 29.
    Perez CA, Grigsby PW, Nene SM et al (1992) Effect of tumor size on the prognosis of carcinoma of the uterine cervix treated with irradiation alone. Cancer 69: 2796–2806PubMedCrossRefGoogle Scholar
  30. 30.
    Perez CA, Kao MS (1985) Radiation therapy alone or combined with surgery in the treatment of barrel-shaped carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys 11: 1903–1909PubMedCrossRefGoogle Scholar
  31. 31.
    Podczaski ES, Palombo C, Manetta A et al (1989) Assessment of pretreatment laparotomy in patients with cervical carcinoma prior to radiotherapy. Gynecol Oncol 33: 71–75PubMedCrossRefGoogle Scholar
  32. 32.
    Potish RA, Twiggs LB, Adcock LL et al (1986) Prognostic importance of progesterone and estrogen receptors in cancer of the uterine cervix. Cancer 58: 1709–1713PubMedCrossRefGoogle Scholar
  33. 33.
    Revesz L (1991) Vascular density in relation to the outcome of radiation therapy: a review. Int J Radiat Oncol Biol Phys 60: 179–182Google Scholar
  34. 34.
    Riou G, Favre M, Jeannel D et al (1990) Association between poor prognosis in early-stage invasive cervical carcinomas and non-detection of HPV DNA. Lancet 335: 1171–1174PubMedCrossRefGoogle Scholar
  35. 35.
    Riou G, Le MG, Favre M et al (1992) Human papillomavirus-negative status and c-myc gene overexpression: independent prognostic indicators of distant metastasis for early-stage invasive cervical cancers. J Natl Cancer Inst 84: 1525–1526PubMedCrossRefGoogle Scholar
  36. 36.
    Rutledge FN, Mitchell MF, Munsell M et al (1992) Youth as a prognostic factor in carcinoma of the cervix: a matched analysis. Gynecol Oncol 44: 123–130PubMedCrossRefGoogle Scholar
  37. 37.
    Seong J, Loh JJ, Kim G et al (1990) Postoperative radiotherapy for stage IB carcinoma of the uterine cervix. Yonsei Med J 31: 367–374PubMedGoogle Scholar
  38. 38.
    Sigurdsson K, Hrafnkelsson J, Geirsson G et al (1991) Screening as a prognostic factor in cervical cancer: analysis of survival and prognostic factors based on Icelandic population data, 1964-1988. Gynecol Oncol 43: 64–70PubMedCrossRefGoogle Scholar
  39. 39.
    Strang P, Stendahl U, Bergstrom R et al (1991) Prognostic flow cytometric information in cervical squamous cell carcinoma; a multivariate analysis of 307 patients. Gynecol Oncol 43: 3–8PubMedCrossRefGoogle Scholar
  40. 40.
    Symonds RP, Habeshaw T, Paul J et al (1992) No correlation between ras, c-myc and c-jun proto-oncogene expression and prognosis in advanced carcinoma of cervix. Eur J Cancer 28: 1615–1617CrossRefGoogle Scholar
  41. 41.
    Van Nagell JR, Donaldson ES, Wood EG et al (1977) Small cell cancer of the uterine cervix. Cancer 40: 2243–2249PubMedCrossRefGoogle Scholar
  42. 42.
    Willen H, Eklund G, Johnsson JE et al (1985) Invasive squamous cell carcinoma of the uterine cervix. VIII. Survival and malignancy grading in patients treated by irradiation in Lund 1969–1970. Acta Radiol (Oncol) 24: 41–50CrossRefGoogle Scholar
  43. 43.
    Zaino R, Ward S, Delgado G et al (1992) Histopathologic predictors of the behavior of surgically treated stage IB squamous cell carcinoma of the cervix. Cancer 69: 1750–1758PubMedCrossRefGoogle Scholar

Copyright information

© International Union Against Cancer, Geneva 1995

Authors and Affiliations

  • A. Fyles
  • P. Kirkbride

There are no affiliations available

Personalised recommendations