Preoperative Prognostic Factors and Effects of Adjuvant Therapy on Outcomes of Early Stage Cervical Cancer in Iran

Background: The aim of this study was to investigate the clinical and histopathological characteristics and the pretreatment that might predict prognosis and to evaluate the impact of postoperative adjuvant therapy on the outcomes of patients with early stage cervical carcinoma. Methods: A total of 203 patients with stage IB and stage II cervical cancers treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy were reviewed at the Vali-Asr University Hospital from 1995 to 2002. The median follow-up period was 42 months. Results: The depth of cervical stromal invasion, clinical stage, histology of pure adenocarcinoma and lymph node (LN) status were important histopathological prognostic factors of cervical carcinoma. Patients' prognosis could be stratified into three groups (low, intermediate and high risk), with five-year relapse free survival (RFS) rates of 93.5%, 80.6% and 64.7%, respectively (p=0.002), and overall survival (OS) was 95.3%, 83.1% and 67.2% (p=0.001). Among the patients with pelvic lymph node metastases who were free of parametrial extension, those who received postoperative chemo-radiotherapy had significantly better RFS (p=0.021) and OS (p=0.030) than those who received no adjuvant therapy. Also of the patients without pelvic LN metastases but at a high risk of recurrence, the individuals who received adjuvant radiotherapy had a significantly more favorable RFS (p=0.038) and a marginally improved OS (p=0.064). Conclusion: Depth of cervical stromal invasion, clinical stage and histology are independent predictors of outcome on multivariate analysis using a Cox regression model. RFS is significantly improved with radiotherapy in patients who are without pelvic lymph node metastases but who are in a high risk group for recurrence.