Surgical-pathological predictors of disease-free survival and risk groupings for IB2 cervical cancer

Do the traditional models still apply?

Scott A. Kamelle, Teresa L. Rutledge, Todd Tillmanns, Natalie S. Gould, David E. Cohn, Jason Wright, Thomas J. Herzog, Janet S. Rader, Michael A. Gold, Gary A. Johnson, Joan L. Walker, Robert S. Mannel, D. Scott McMeekin

Research output: Contribution to journalArticle

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Abstract

Objective. To evaluate how the independent predictors of recurrence for stage IB2 cervical cancers treated with up-front radical hysterectomy apply to established risk models. Methods. Patients with IB2 cervical cancers diagnosed from 1990 to 2000 were identified from tumor registries of two institutions. Patients were classified into risk groups: high-risk (HR) (positive nodes, parametria, or margins), intermediate-risk (IR) (positive lymph vascular space involvement (LVSI) with any cervical stromal invasion (CSI), or (-) LVSI and > middle- CSI), or low-risk (LR) (absence of HR or IR characteristics). Disease-free survival (DFS) was estimated by Kaplan-Meier method and comparisons between subgroups were studied by log rank. A Cox proportional hazards model was used to determine independent predictors of recurrence. Results. We identified 86 patients with stage IB2 tumors treated by RH. We found 34% of patients to be HR, 60% IR, and 6% LR. Of the 52 IR patients, 28 had (+) LVSI with superficial, middle, and outer 1/3 CSI, and 24 had (-) LVSI with middle or outer 1/3 invasion. Overall, postoperative adjuvant radiation (PRT) was used in 52% of the 86 patients, including 0/5 LR, 16/52 IR, and 29/29 HR patients. Univariate predictors of recurrence were pelvic nodal disease, (+) LVSI, (+) parametria, outer 1/3 CSI, and tumor size > 6 cm. Age, grade, histology, and the use of postoperative radiation were not associated with recurrence. Multivariate analysis identified LVSI as the only independent predictor of recurrence (RR 5.2, P = 0.03). Two-year DFS for LR, IR, and HR patients was 100%, 83%, and 60%, respectively. Only 4/24 (17%) IR patients with (-) LVSI got PRT compared with 12/28 (43%) of IR patients with (+) LVSI. The 2-year DFS for IR patients with (-) LVSI was 96%. IR (+) patients recurred more frequently with a 2-year DFS of 71%. Conclusions. Overall, 66% of patients with IB2 disease were classified as having low or intermediate-risk disease. IR patients with (-) LVSI and all LR patients did well with surgery alone. This study defines the independent importance of LVSI and questions the utility of published IR models when applied to stage IB2 cervical cancer.

Original languageEnglish (US)
Pages (from-to)249-255
Number of pages7
JournalGynecologic Oncology
Volume94
Issue number2
DOIs
StatePublished - Aug 1 2004
Externally publishedYes

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Uterine Cervical Neoplasms
Disease-Free Survival
Lymph
Blood Vessels
Recurrence
Peritoneum
Radiation
Neoplasms

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynecology
  • Oncology

Cite this

Surgical-pathological predictors of disease-free survival and risk groupings for IB2 cervical cancer : Do the traditional models still apply? / Kamelle, Scott A.; Rutledge, Teresa L.; Tillmanns, Todd; Gould, Natalie S.; Cohn, David E.; Wright, Jason; Herzog, Thomas J.; Rader, Janet S.; Gold, Michael A.; Johnson, Gary A.; Walker, Joan L.; Mannel, Robert S.; Scott McMeekin, D.

In: Gynecologic Oncology, Vol. 94, No. 2, 01.08.2004, p. 249-255.

Research output: Contribution to journalArticle

Kamelle, SA, Rutledge, TL, Tillmanns, T, Gould, NS, Cohn, DE, Wright, J, Herzog, TJ, Rader, JS, Gold, MA, Johnson, GA, Walker, JL, Mannel, RS & Scott McMeekin, D 2004, 'Surgical-pathological predictors of disease-free survival and risk groupings for IB2 cervical cancer: Do the traditional models still apply?', Gynecologic Oncology, vol. 94, no. 2, pp. 249-255. https://doi.org/10.1016/j.ygyno.2004.05.038
Kamelle, Scott A. ; Rutledge, Teresa L. ; Tillmanns, Todd ; Gould, Natalie S. ; Cohn, David E. ; Wright, Jason ; Herzog, Thomas J. ; Rader, Janet S. ; Gold, Michael A. ; Johnson, Gary A. ; Walker, Joan L. ; Mannel, Robert S. ; Scott McMeekin, D. / Surgical-pathological predictors of disease-free survival and risk groupings for IB2 cervical cancer : Do the traditional models still apply?. In: Gynecologic Oncology. 2004 ; Vol. 94, No. 2. pp. 249-255.
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title = "Surgical-pathological predictors of disease-free survival and risk groupings for IB2 cervical cancer: Do the traditional models still apply?",
abstract = "Objective. To evaluate how the independent predictors of recurrence for stage IB2 cervical cancers treated with up-front radical hysterectomy apply to established risk models. Methods. Patients with IB2 cervical cancers diagnosed from 1990 to 2000 were identified from tumor registries of two institutions. Patients were classified into risk groups: high-risk (HR) (positive nodes, parametria, or margins), intermediate-risk (IR) (positive lymph vascular space involvement (LVSI) with any cervical stromal invasion (CSI), or (-) LVSI and > middle- CSI), or low-risk (LR) (absence of HR or IR characteristics). Disease-free survival (DFS) was estimated by Kaplan-Meier method and comparisons between subgroups were studied by log rank. A Cox proportional hazards model was used to determine independent predictors of recurrence. Results. We identified 86 patients with stage IB2 tumors treated by RH. We found 34{\%} of patients to be HR, 60{\%} IR, and 6{\%} LR. Of the 52 IR patients, 28 had (+) LVSI with superficial, middle, and outer 1/3 CSI, and 24 had (-) LVSI with middle or outer 1/3 invasion. Overall, postoperative adjuvant radiation (PRT) was used in 52{\%} of the 86 patients, including 0/5 LR, 16/52 IR, and 29/29 HR patients. Univariate predictors of recurrence were pelvic nodal disease, (+) LVSI, (+) parametria, outer 1/3 CSI, and tumor size > 6 cm. Age, grade, histology, and the use of postoperative radiation were not associated with recurrence. Multivariate analysis identified LVSI as the only independent predictor of recurrence (RR 5.2, P = 0.03). Two-year DFS for LR, IR, and HR patients was 100{\%}, 83{\%}, and 60{\%}, respectively. Only 4/24 (17{\%}) IR patients with (-) LVSI got PRT compared with 12/28 (43{\%}) of IR patients with (+) LVSI. The 2-year DFS for IR patients with (-) LVSI was 96{\%}. IR (+) patients recurred more frequently with a 2-year DFS of 71{\%}. Conclusions. Overall, 66{\%} of patients with IB2 disease were classified as having low or intermediate-risk disease. IR patients with (-) LVSI and all LR patients did well with surgery alone. This study defines the independent importance of LVSI and questions the utility of published IR models when applied to stage IB2 cervical cancer.",
author = "Kamelle, {Scott A.} and Rutledge, {Teresa L.} and Todd Tillmanns and Gould, {Natalie S.} and Cohn, {David E.} and Jason Wright and Herzog, {Thomas J.} and Rader, {Janet S.} and Gold, {Michael A.} and Johnson, {Gary A.} and Walker, {Joan L.} and Mannel, {Robert S.} and {Scott McMeekin}, D.",
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T1 - Surgical-pathological predictors of disease-free survival and risk groupings for IB2 cervical cancer

T2 - Do the traditional models still apply?

AU - Kamelle, Scott A.

AU - Rutledge, Teresa L.

AU - Tillmanns, Todd

AU - Gould, Natalie S.

AU - Cohn, David E.

AU - Wright, Jason

AU - Herzog, Thomas J.

AU - Rader, Janet S.

AU - Gold, Michael A.

AU - Johnson, Gary A.

AU - Walker, Joan L.

AU - Mannel, Robert S.

AU - Scott McMeekin, D.

PY - 2004/8/1

Y1 - 2004/8/1

N2 - Objective. To evaluate how the independent predictors of recurrence for stage IB2 cervical cancers treated with up-front radical hysterectomy apply to established risk models. Methods. Patients with IB2 cervical cancers diagnosed from 1990 to 2000 were identified from tumor registries of two institutions. Patients were classified into risk groups: high-risk (HR) (positive nodes, parametria, or margins), intermediate-risk (IR) (positive lymph vascular space involvement (LVSI) with any cervical stromal invasion (CSI), or (-) LVSI and > middle- CSI), or low-risk (LR) (absence of HR or IR characteristics). Disease-free survival (DFS) was estimated by Kaplan-Meier method and comparisons between subgroups were studied by log rank. A Cox proportional hazards model was used to determine independent predictors of recurrence. Results. We identified 86 patients with stage IB2 tumors treated by RH. We found 34% of patients to be HR, 60% IR, and 6% LR. Of the 52 IR patients, 28 had (+) LVSI with superficial, middle, and outer 1/3 CSI, and 24 had (-) LVSI with middle or outer 1/3 invasion. Overall, postoperative adjuvant radiation (PRT) was used in 52% of the 86 patients, including 0/5 LR, 16/52 IR, and 29/29 HR patients. Univariate predictors of recurrence were pelvic nodal disease, (+) LVSI, (+) parametria, outer 1/3 CSI, and tumor size > 6 cm. Age, grade, histology, and the use of postoperative radiation were not associated with recurrence. Multivariate analysis identified LVSI as the only independent predictor of recurrence (RR 5.2, P = 0.03). Two-year DFS for LR, IR, and HR patients was 100%, 83%, and 60%, respectively. Only 4/24 (17%) IR patients with (-) LVSI got PRT compared with 12/28 (43%) of IR patients with (+) LVSI. The 2-year DFS for IR patients with (-) LVSI was 96%. IR (+) patients recurred more frequently with a 2-year DFS of 71%. Conclusions. Overall, 66% of patients with IB2 disease were classified as having low or intermediate-risk disease. IR patients with (-) LVSI and all LR patients did well with surgery alone. This study defines the independent importance of LVSI and questions the utility of published IR models when applied to stage IB2 cervical cancer.

AB - Objective. To evaluate how the independent predictors of recurrence for stage IB2 cervical cancers treated with up-front radical hysterectomy apply to established risk models. Methods. Patients with IB2 cervical cancers diagnosed from 1990 to 2000 were identified from tumor registries of two institutions. Patients were classified into risk groups: high-risk (HR) (positive nodes, parametria, or margins), intermediate-risk (IR) (positive lymph vascular space involvement (LVSI) with any cervical stromal invasion (CSI), or (-) LVSI and > middle- CSI), or low-risk (LR) (absence of HR or IR characteristics). Disease-free survival (DFS) was estimated by Kaplan-Meier method and comparisons between subgroups were studied by log rank. A Cox proportional hazards model was used to determine independent predictors of recurrence. Results. We identified 86 patients with stage IB2 tumors treated by RH. We found 34% of patients to be HR, 60% IR, and 6% LR. Of the 52 IR patients, 28 had (+) LVSI with superficial, middle, and outer 1/3 CSI, and 24 had (-) LVSI with middle or outer 1/3 invasion. Overall, postoperative adjuvant radiation (PRT) was used in 52% of the 86 patients, including 0/5 LR, 16/52 IR, and 29/29 HR patients. Univariate predictors of recurrence were pelvic nodal disease, (+) LVSI, (+) parametria, outer 1/3 CSI, and tumor size > 6 cm. Age, grade, histology, and the use of postoperative radiation were not associated with recurrence. Multivariate analysis identified LVSI as the only independent predictor of recurrence (RR 5.2, P = 0.03). Two-year DFS for LR, IR, and HR patients was 100%, 83%, and 60%, respectively. Only 4/24 (17%) IR patients with (-) LVSI got PRT compared with 12/28 (43%) of IR patients with (+) LVSI. The 2-year DFS for IR patients with (-) LVSI was 96%. IR (+) patients recurred more frequently with a 2-year DFS of 71%. Conclusions. Overall, 66% of patients with IB2 disease were classified as having low or intermediate-risk disease. IR patients with (-) LVSI and all LR patients did well with surgery alone. This study defines the independent importance of LVSI and questions the utility of published IR models when applied to stage IB2 cervical cancer.

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