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Prognostic factors in advanced stage squamous cell cancer of the cervix
Author(s) -
Hopkins Michael P.,
Morley George W.
Publication year - 1993
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19931015)72:8<2389::aid-cncr2820720816>3.0.co;2-r
Subject(s) - medicine , squamous cell cancer , cervix , stage (stratigraphy) , cancer , oncology , basal cell , gynecology , paleontology , biology
Background . This study was undertaken to review prognostic factors for advanced squamous cell cancer of the cervix. Methods . A clinicopathologic review of patients diagnosed with advanced stage squamous cell cancer of the cervix was performed at the University of Michigan Medical Center, Ann Arbor, Michigan, from 1970–1985. Results . All patients had squamous cell disease and were divided according to the following stages: Stage IIIa (4), Stage IIIb (113), Stage IVa (32), and Stage IVb (26). The cumulative 5‐year survival was as follows: Stage IIIa (50%), Stage IIIb (37%), Stage IVa (14%), and Stage IVb (4%). Prognostic features for Stage IIIb disease showed that the intravenous pyelogram status significantly predicted cumulative 5‐year survival ( P = 0.00001). When the intravenous pyelogram was normal, 47% survived. When ureteral obstruction was present without renal failure, 29% survived, and when renal failure occurred, all patients were dead of disease by 16 months. The lymph node status significantly influenced cumulative 5‐year survival ( P = 0.004). When lymph nodes were negative, 47% survived. When three or fewer were positive, 44% survived. When more than three were positive, 11% survived. When pelvic lymph nodes were positive and paraaortic node status was determined, 25% survived when paraaortic lymph nodes were negative, while 8% survived when these were positive ( P = 0.06). Factors that did not influence 5‐year survival included one or both sidewall involvement ( P = 0.77), tumor grade ( P = 0.23), diabetes ( P = 0.92), hypertension ( P = 0.85), and obesity ( P = 0.47). The diagnosis of Stage IVa disease was made by the presence of fistula at initial presentation (n = 8), cystoscopy (n = 21), and sigmoidoscopy (n = 1). One patient developed a treatment‐related vesicovaginal fistula when bladder involvement was diagnosed by cystoscopy. Ah 18 patients who presented with renal failure (Stage IIIb, 9; Stage IVa, 9) were analyzed as a group, and only 1 patient survived. The median survival in 15 patients who underwent nephrostomy was 8 months, range 1–36 months. Ten of 15 patients (66%) were dead of disease within 1 year. Three patients refused renal bypass, and these three patients died at 1,2, and 3 months, respectively. Conclusions . Advanced stage disease represents a significant challenge, and when ureteral obstruction or renal failure is present, the prognosis is markedly decreased.