Multivariate analysis of prognostic factors in patients with stage IB cervical cancer who underwent radical hysterectomy
Öz
Abstract
Aim. The aim of this study was to assess the effects of prognostic factors on survival of cervical cancer patients. Methods. Data obtained from 193 patients who had been diagnosed as stage IB cervical cancer and underwent a type III radical hysterectomy and a systematic bilateral pelvic plus para-aortic lymphadenectomy between 1993 and 2007 were reviewed. Results. Twenty-three were excluded from the study as they have lost to follow-up immediately after surgery. Mean age was 53 years and median follow up was 62 months. During follow-up, recurrence was developed in 27 patients, while 26 died. In univariate analysis, the presence of metastasis in any lymph node, involvement of pelvic or para-aortic lymph nodes and adjuvant radiotherapy were significant factors in terms of disease free survival (DFS) and overall survival (OS) rate. Age and the lymphovascular space invasion were significant factors only for OS rate, whereas the depth of stromal invasion only for DFS rate. Tumor size, stage, cell type, grade, parametrial involvement, and positive surgical margins had no prognostic value. In multivariate analysis, presence of metastasis in any lymph node, pelvic lymph node involvement and age were found as independent prognostic factors for both DFS and OS. Stromal invasion was found as an independent prognostic factor only for DFS. However, no significance was found for para-aortic lymph node involvement, lymphovascular space invasion and adjuvant therapy. Conclusion. In the present study, only the lymph node status was an important factor among those determining patients with a high risk after early stage radical hysterectomy. Furthermore, it was found that age also had an important effect on survival rate as much as lymph node status had.
Key words: Cervical cancer, prognostic factors.
Özet
Amaç. Bu çalışmada serviks kanserinde prognostik etkisi olduğu düşünülen faktörlerin yaşam oranları üzerindeki etkisi değerlendirildi. Yöntem. 1993-2007 tarihleri arasında evre IB serviks kanseri tanısı alan, tip III radikal histerektomi ve sistematik bilateral pelvik+para-aortik lenfadenektomi geçiren 193 hastanın verileri gözden geçirildi. Bulgular. 23 hasta cerrahiden hemen sonra kontrollere gelmediğinden çalışma dışı bırakıldı. Değerlendirilen 170 hastanın yaş ortalaması 53 yıldı, ortanca takip süresi 62 aydı. Bu süre içinde 27 hastada nüks geliştiği ve 26 hastanın öldüğü belirlendi. Univaryant analizde herhangi bir lenf nodunda metastaz varlığı, pelvik veya para-aortik lenf nodu tutulumu ve adjuvan radyoterapi hastalıksız yaşam oranı (DFS) ve sağ kalım oranı (OS) için anlamlıydı. Yaş ve lenfovasküler alan invazyonu sadece OS için, stromal invazyon derinliğiyse sadece DFS için anlam taşımaktaydı. Tümör boyutu, evre, hücre tipi, grade , parametrial tutulum ve cerrahi sınır pozitifliğinin prognostik değerinin olmadığı görüldü. Multivaryant analizde ise herhangi bir lenf nodunda metastaz varlığı, pelvik lenf nodu tutulumu ve yaşın, hem DFS hemde OS için bağımsız prognostik faktörler olduğu saptandı. Stromal invazyon sadece DFS için bağımsız prognostik faktördü. Buna karşın para-aortik lenf nodu tutulumu, lenfovasküler alan invazyonu ve adjuvan radyoterapinin anlamlı olmadığı belirlendi. Sonuç. Bu çalışmada erken evrede radikal histerektomi sonrası yüksek-riskli grubu belirleyen faktörlerden sadece lenf nodu durumunun önemli olduğu görüldü. Bunun yanı sıra yaşın lenf nodu durumu kadar yaşam oranları üzerine etkili olduğu saptandı.
Anahtar sözcükler: Serviks kanseri, Prognostik faktörler
Anahtar Kelimeler
Kaynakça
- Creasman WT. New gynecologic cancer staging. Gynecol Oncol 1995; 58: 157-8.
- Rutledge TL, Kamelle SA, Tillmanns TD, Gould NS, Wright JD, Cohn DE, Herzog TJ, Rader JS, Gold MA, Johnson GA, Walker JL, Mannel RS, McMeekin DS. A comparison of stage IB1 and IB2 cervical cancers treated with radical hysterectomy. Is size the real difference? Gynecol Oncol 2004; 95: 70-6.
- Horn LC, Fischer U, Raptis G, Bilek K, Hentschel B. Tumor size is of prognostic value in surgically treated FIGO stage II cervical cancer. Gynecol Oncol. 2007; 107: 310-5.
- Finan MA, DeCesare S, Fiorica JV, Chambers R, Hoffman MS, Kline RC, Roberts WS, Cavanagh D. Radical hysterectomy for stage IB1 vs IB2 carcinoma of the cervix: Does the new staging system predict morbidity and survival? Gynecol Oncol. 1996; 62: 139-47.
- Sevin BU, Nadji M, Lampe B, Lu Y, Hilsenbeck S, Koechli OR, Averette HE. Prognostic factors of early stage cervical cancer treated by radical hysterectomy. Cancer. 1995; 76: 1978-86.
- Kawagoe T, Kashimura M, Matsuura Y, Sugihara K, Toki N, Aoki T. Clinical significance of tumor size in stage IB and II carcinoma of the uterine cervix. Int J Gynecol Cancer. 1999; 9: 421-6.
- Kristensen GB, Abeler VA, Risberg B, Trope C, Bryne M. Tumor size, depth of invasion, and grading of the invasive tumor front are the main prognostic factors in early squamous cell cervical carcinoma. Gynecol Oncol 1999; 74:245-51.
- Kamelle SA, Rutledge TL, Tillmanns TD, Gould NS, Cohn DE, Wright J, Herzog TJ, Rader JS, Gold MA, Johnson GA, Walker JL, Mannel RS, McMeekin DS. Surgical-pathological predictors of disease-free survival and risk groupings for IB2 cervical cancer: do the traditional models still apply? Gynecol Oncol 2004; 94: 249-55.
- Trattner M, Graf AH, Lax S, Forstner R, Dandachi N, Haas J, Pickel H, Reich O, Staudach A, Winter R. Prognostic factors in surgically treated stage Ib-IIb cervical carcinomas with special emphasis on the importance of tumor volume. Gynecol Oncol. 2001; 82: 11-6.
- Kovalic JJ, Perez CA, Grigsby PW, Lockett MA. The effect of volume of disease in patients with carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys 1991; 21: 905-10.
- Lee JM, Lee KB, Park CY. Prognostic factors predicting survival in patients with FIGO stage IB cervical cancer treated surgically. Int J Gynaecol Obstet 2006; 94: 143-4.
- Comerci G, Bolger BS, Flannelly G, Maini M, de Barros Lopes A, Monaghan JM. Prognostic factors in surgically treated stage IB-IIB carcinoma of the cervix with negative lymph nodes. Int J Gynecol Cancer. 1998; 8: 23-6.
- Burghardt E, Baltzer J, Tulusan AH, Haas J. Results of surgical treatment of 1028 cervical cancers studied with volumetry. Cancer 1992; 70: 648-55.
- Fyles AW, Pintilie M, Kirkbride P, Levin W, Manchul LA, Rawlings GA.Prognostic factors in patients with cervix cancer treated by radiation therapy: results of a multiple regression analysis. Radiother Oncol 1995; 35:107-17.
- Trimbos JB, Lambeek AF, Peters AA, Wolterbeek R, Gaarenstroom KN, Fleuren GJ, Kenter GG. Prognostic difference of surgical treatment of exophytic versus barrel-shaped bulky cervical cancer. Gynecol Oncol 2004; 95:77-81.
- Stehman FB, Bundy BN, DiSaia PJ, Keys HM, Larson JE, Fowler WC. Carcinoma of the cervix treated with radiation therapy. I. A multi-variate analysis of prognostic variables in the Cancer. 1991; 67: 2776-85.
- Grigsby PW, Perez CA, Chao KS, Elbendary A, Herzog TJ, Rader JS, Mutch DG. Lack of effect of tumor size on the prognosis of carcinoma of the uterine cervix Stage IB and IIA treated with preoperative irradiation and surgery. Int J Radiat Oncol Biol Phys. 1999;45: 645-51.
- Metindir J, Bilir G. Prognostic factors affecting disease-free survival in early- stage cervical cancer patients undergoing radical hysterectomy and pelvic- paraaortic lymphadenectomy. Eur J Gynaecol Oncol 2007; 28: 28-32.
- Wagenaar HC, Trimbos JB, Postema S, Anastasopoulou A, van der Geest RJ, Reiber JH, Kenter GG, Peters AA, Pattynama PM. Tumor diameter and volume assessed by magnetic resonance imaging in the prediction of outcome for invasive cervical cancer. Gynecol Oncol 2001; 82:474-82.
- Rettenmaier MA, Casanova DM, Micha JP, Moran MF, Ramsanghani NS, Syed NA, Puthawala A, DiSaia PJ. Radical hysterectomy and tailored postoperative radiation therapy in the management of bulky stage 1B cervical cancer. Cancer 1989; 63: 2220-3.
- Delgado G, Bundy BN, Fowler WC Jr, Stehman FB, Sevin B, Creasman WT, Major F, DiSaia P, Zaino R. A prospective surgical pathological study of stage I squamous carcinoma of the cervix: a Gynecologic Oncology Group Study. Gynecol Oncol 1989 ; 35: 314-20.
- Homesley HD, Raben M, Blake DD, Ferree CR, Bullock MS, Linton EB, Greiss FCJr, Rhyne AL. Relationship of lesion size to survival in patients with stage IB squamous cell carcinoma of the cervix uteri treated by radiation therapy. Surg Gynecol Obstet 1980 ;150: 529-31.
- Alvarez RD, Gelder MS, Gore H, Soong SJ, Partridge EE. Radical hysterectomy in the treatment of patients with bulky early stage carcinoma of the cervix uteri. Surg Gynecol Obstet 1993 ;176:539-42.
- Perez CA, Grigsby PW, Nene SM, Camel HM, Galakatos A, Kao MS, Lockett MA. Effect of tumor size on the prognosis of carcinoma of the uterine cervix treated with irradiation alone. Cancer 1992 ; 69: 2796-806.
- Kapp DS, Fischer D, Gutierrez E, Kohorn EI, Schwartz PE. 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 1983; 9: 445-55.
- Lowrey GC, Mendenhall WM, Million RR. Stage IB or IIA-B carcinoma of the intact uterine cervix treated with irradiation: a multivariate analysis. Int J Radiat Oncol Biol Phys 1992; 24: 205-10,
- Gardin E, Cnattingius S, Jhonson P, Petterson B. Prognostic factors and relapse patterns in early-stage cervical carcinoma after brachytherapy and radical hysterectomy. Gynecol Oncol 1994; 53: 314-9.
- Alvarez RD, Soong SJ, Kinney WK, Reid GC, Schray MF, Podratz KC, Morley GW, Shingleton HM. 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 1989 ; 35: 130-5.
- Podczaski ES, Palombo C, Manetta A, Andrews C, Larson J, DeGeest K, Mortel R. Assessment of pretreatment laparotomy in patients with cervical carcinoma prior to radiotherapy. Gynecol Oncol 1989 ; 33: 71-5.
- Delgado G, Bundy B, Zaino R, Sevin BU, Creasman WT, Major F. Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol 1990 ; 38: 352-7.
- Takeda N, Sakuragi N, Takeda M, Okamoto K, Kuwabara M, Negishi H, Oikawa M, Yamamoto R, Yamada H, Fujimoto S. Multivariate analysis of histopathologic prognostic factors for invasive cervical cancer treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy. Acta Obstet Gynecol Scand 2002 ; 81: 1144-51.
- Perez CA, Grigsby PW, Chao KS, Mutch DG, Lockett MA. Tumor size, irradiation dose, and long-term outcome of carcinoma of uterine cervix. Int J Radiat Oncol Biol Phys 1998; 41: 307-17.
- Ho CM, Chien TY, Huang SH, Wu CJ, Shih BY, Chang SC. Multivariate analysis of the prognostic factors and outcomes in early cervical cancer patients undergoing radical hysterectomy. Gynecol Oncol 2004; 93: 458-64.
- Samlal RA, van der Velden J, Ten Kate FJ, Schilthuis MS, Hart AA, Lammes FB. Surgical pathologic factors that predict recurrence in stage IB and IIA cervical carcinoma patients with negative pelvic lymph nodes. Cancer 1997; 80: 1234-40.
- Prempree T, Patanephan V, Sewhand W, Scott RM. The influence of patient’s age and tumor grade on the prognosis of carcinoma of the cervix. Cancer 1983; 51: 1764-71.
- Stanhope CR, Smith JP, Wharton JT, Rutledge FN, Fletcher GH, Gallager HS. Carcinoma of the cervix: the effect of age on survival. Gynecol Oncol 1980; 10: 188-93.
- van der Graff Y, Peer PGM, Ziclhuis GA, Vooijs PG. Cervical cancer survival in Nijmegan region, The Netherlands, 1970-1985. Gynecol Oncol 1988; 30: 51-56.
- Meanwell CA, Kelly KA, Wilson S, Roginski C, Woodman C, Griffiths R, Blackledge G. Young age as a prognostic factor in cervical cancer: analysis of population based data from 10,022 cases. Br Med J (Clin Res Ed). 1988 6; 296: 386-91.
- Sigurdsson K, Hrafnkelsson J, Geirsson G, Gudmundsson J, Salvarsdóttir A. Screening as a prognostic factor in cervical cancer: analysis of survival and prognostic factors based on Icelandic population data, 1964-1988. Gynecol Oncol 1991 ; 43: 64-70.
- Lai CH, Hong JH, Hsueh S, Ng KK, Chang TC, Tseng CJ, Chou HH, Huang KG. Preoperative prognostic variables and the impact of postoperative adjuvant therapy on the outcomes of Stage IB or II cervical carcinoma patients with or without pelvic lymph node metastases: an analysis of 891 cases. Cancer. 1999; 85: 1537-46.
- Paley PJ, Goff BA, Minudri R, Greer BE, Tamimi HK, Koh WJ. The prognostic significance of radiation dose and residual tumor in the treatment of barrel- shaped endophytic cervical carcinoma. Gynecol Oncol 2000; 76: 373-9.
Öz
Amaç. Bu çalışmada serviks kanserinde prognostik etkisi olduğu düşünülen faktörlerin yaşam oranları üzerindeki etkisi değerlendirildi. Yöntem. 1993-2007 tarihleri arasında evre IB serviks kanseri tanısı alan, tip III radikal histerektomi ve sistematik bilateral pelvik+para-aortik lenfadenektomi geçiren 193 hastanın verileri gözden geçirildi. Bulgular. 23 hasta cerrahiden hemen sonra kontrollere gelmediğinden çalışma dışı bırakıldı. Değerlendirilen 170 hastanın yaş ortalaması 53 yıldı, ortanca takip süresi 62 aydı. Bu süre içinde 27 hastada nüks geliştiği ve 26 hastanın öldüğü belirlendi. Univaryant analizde herhangi bir lenf nodunda metastaz varlığı, pelvik veya para-aortik lenf nodu tutulumu ve adjuvan radyoterapi hastalıksız yaşam oranı (DFS) ve sağ kalım oranı (OS) için anlamlıydı. Yaş ve lenfovasküler alan invazyonu sadece OS için, stromal invazyon derinliğiyse sadece DFS için anlam taşımaktaydı. Tümör boyutu, evre, hücre tipi, grade , parametrial tutulum ve cerrahi sınır pozitifliğinin prognostik değerinin olmadığı görüldü. Multivaryant analizde ise herhangi bir lenf nodunda metastaz varlığı, pelvik lenf nodu tutulumu ve yaşın, hem DFS hemde OS için bağımsız prognostik faktörler olduğu saptandı. Stromal invazyon sadece DFS için bağımsız prognostik faktördü. Buna karşın para-aortik lenf nodu tutulumu, lenfovasküler alan invazyonu ve adjuvan radyoterapinin anlamlı olmadığı belirlendi. Sonuç. Bu çalışmada erken evrede radikal histerektomi sonrası yüksek-riskli grubu belirleyen faktörlerden sadece lenf nodu durumunun önemli olduğu görüldü. Bunun yanı sıra yaşın lenf nodu durumu kadar yaşam oranları üzerine etkili olduğu saptandı
Anahtar Kelimeler
Kaynakça
- Creasman WT. New gynecologic cancer staging. Gynecol Oncol 1995; 58: 157-8.
- Rutledge TL, Kamelle SA, Tillmanns TD, Gould NS, Wright JD, Cohn DE, Herzog TJ, Rader JS, Gold MA, Johnson GA, Walker JL, Mannel RS, McMeekin DS. A comparison of stage IB1 and IB2 cervical cancers treated with radical hysterectomy. Is size the real difference? Gynecol Oncol 2004; 95: 70-6.
- Horn LC, Fischer U, Raptis G, Bilek K, Hentschel B. Tumor size is of prognostic value in surgically treated FIGO stage II cervical cancer. Gynecol Oncol. 2007; 107: 310-5.
- Finan MA, DeCesare S, Fiorica JV, Chambers R, Hoffman MS, Kline RC, Roberts WS, Cavanagh D. Radical hysterectomy for stage IB1 vs IB2 carcinoma of the cervix: Does the new staging system predict morbidity and survival? Gynecol Oncol. 1996; 62: 139-47.
- Sevin BU, Nadji M, Lampe B, Lu Y, Hilsenbeck S, Koechli OR, Averette HE. Prognostic factors of early stage cervical cancer treated by radical hysterectomy. Cancer. 1995; 76: 1978-86.
- Kawagoe T, Kashimura M, Matsuura Y, Sugihara K, Toki N, Aoki T. Clinical significance of tumor size in stage IB and II carcinoma of the uterine cervix. Int J Gynecol Cancer. 1999; 9: 421-6.
- Kristensen GB, Abeler VA, Risberg B, Trope C, Bryne M. Tumor size, depth of invasion, and grading of the invasive tumor front are the main prognostic factors in early squamous cell cervical carcinoma. Gynecol Oncol 1999; 74:245-51.
- Kamelle SA, Rutledge TL, Tillmanns TD, Gould NS, Cohn DE, Wright J, Herzog TJ, Rader JS, Gold MA, Johnson GA, Walker JL, Mannel RS, McMeekin DS. Surgical-pathological predictors of disease-free survival and risk groupings for IB2 cervical cancer: do the traditional models still apply? Gynecol Oncol 2004; 94: 249-55.
- Trattner M, Graf AH, Lax S, Forstner R, Dandachi N, Haas J, Pickel H, Reich O, Staudach A, Winter R. Prognostic factors in surgically treated stage Ib-IIb cervical carcinomas with special emphasis on the importance of tumor volume. Gynecol Oncol. 2001; 82: 11-6.
- Kovalic JJ, Perez CA, Grigsby PW, Lockett MA. The effect of volume of disease in patients with carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys 1991; 21: 905-10.
- Lee JM, Lee KB, Park CY. Prognostic factors predicting survival in patients with FIGO stage IB cervical cancer treated surgically. Int J Gynaecol Obstet 2006; 94: 143-4.
- Comerci G, Bolger BS, Flannelly G, Maini M, de Barros Lopes A, Monaghan JM. Prognostic factors in surgically treated stage IB-IIB carcinoma of the cervix with negative lymph nodes. Int J Gynecol Cancer. 1998; 8: 23-6.
- Burghardt E, Baltzer J, Tulusan AH, Haas J. Results of surgical treatment of 1028 cervical cancers studied with volumetry. Cancer 1992; 70: 648-55.
- Fyles AW, Pintilie M, Kirkbride P, Levin W, Manchul LA, Rawlings GA.Prognostic factors in patients with cervix cancer treated by radiation therapy: results of a multiple regression analysis. Radiother Oncol 1995; 35:107-17.
- Trimbos JB, Lambeek AF, Peters AA, Wolterbeek R, Gaarenstroom KN, Fleuren GJ, Kenter GG. Prognostic difference of surgical treatment of exophytic versus barrel-shaped bulky cervical cancer. Gynecol Oncol 2004; 95:77-81.
- Stehman FB, Bundy BN, DiSaia PJ, Keys HM, Larson JE, Fowler WC. Carcinoma of the cervix treated with radiation therapy. I. A multi-variate analysis of prognostic variables in the Cancer. 1991; 67: 2776-85.
- Grigsby PW, Perez CA, Chao KS, Elbendary A, Herzog TJ, Rader JS, Mutch DG. Lack of effect of tumor size on the prognosis of carcinoma of the uterine cervix Stage IB and IIA treated with preoperative irradiation and surgery. Int J Radiat Oncol Biol Phys. 1999;45: 645-51.
- Metindir J, Bilir G. Prognostic factors affecting disease-free survival in early- stage cervical cancer patients undergoing radical hysterectomy and pelvic- paraaortic lymphadenectomy. Eur J Gynaecol Oncol 2007; 28: 28-32.
- Wagenaar HC, Trimbos JB, Postema S, Anastasopoulou A, van der Geest RJ, Reiber JH, Kenter GG, Peters AA, Pattynama PM. Tumor diameter and volume assessed by magnetic resonance imaging in the prediction of outcome for invasive cervical cancer. Gynecol Oncol 2001; 82:474-82.
- Rettenmaier MA, Casanova DM, Micha JP, Moran MF, Ramsanghani NS, Syed NA, Puthawala A, DiSaia PJ. Radical hysterectomy and tailored postoperative radiation therapy in the management of bulky stage 1B cervical cancer. Cancer 1989; 63: 2220-3.
- Delgado G, Bundy BN, Fowler WC Jr, Stehman FB, Sevin B, Creasman WT, Major F, DiSaia P, Zaino R. A prospective surgical pathological study of stage I squamous carcinoma of the cervix: a Gynecologic Oncology Group Study. Gynecol Oncol 1989 ; 35: 314-20.
- Homesley HD, Raben M, Blake DD, Ferree CR, Bullock MS, Linton EB, Greiss FCJr, Rhyne AL. Relationship of lesion size to survival in patients with stage IB squamous cell carcinoma of the cervix uteri treated by radiation therapy. Surg Gynecol Obstet 1980 ;150: 529-31.
- Alvarez RD, Gelder MS, Gore H, Soong SJ, Partridge EE. Radical hysterectomy in the treatment of patients with bulky early stage carcinoma of the cervix uteri. Surg Gynecol Obstet 1993 ;176:539-42.
- Perez CA, Grigsby PW, Nene SM, Camel HM, Galakatos A, Kao MS, Lockett MA. Effect of tumor size on the prognosis of carcinoma of the uterine cervix treated with irradiation alone. Cancer 1992 ; 69: 2796-806.
- Kapp DS, Fischer D, Gutierrez E, Kohorn EI, Schwartz PE. 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 1983; 9: 445-55.
- Lowrey GC, Mendenhall WM, Million RR. Stage IB or IIA-B carcinoma of the intact uterine cervix treated with irradiation: a multivariate analysis. Int J Radiat Oncol Biol Phys 1992; 24: 205-10,
- Gardin E, Cnattingius S, Jhonson P, Petterson B. Prognostic factors and relapse patterns in early-stage cervical carcinoma after brachytherapy and radical hysterectomy. Gynecol Oncol 1994; 53: 314-9.
- Alvarez RD, Soong SJ, Kinney WK, Reid GC, Schray MF, Podratz KC, Morley GW, Shingleton HM. 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 1989 ; 35: 130-5.
- Podczaski ES, Palombo C, Manetta A, Andrews C, Larson J, DeGeest K, Mortel R. Assessment of pretreatment laparotomy in patients with cervical carcinoma prior to radiotherapy. Gynecol Oncol 1989 ; 33: 71-5.
- Delgado G, Bundy B, Zaino R, Sevin BU, Creasman WT, Major F. Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol 1990 ; 38: 352-7.
- Takeda N, Sakuragi N, Takeda M, Okamoto K, Kuwabara M, Negishi H, Oikawa M, Yamamoto R, Yamada H, Fujimoto S. Multivariate analysis of histopathologic prognostic factors for invasive cervical cancer treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy. Acta Obstet Gynecol Scand 2002 ; 81: 1144-51.
- Perez CA, Grigsby PW, Chao KS, Mutch DG, Lockett MA. Tumor size, irradiation dose, and long-term outcome of carcinoma of uterine cervix. Int J Radiat Oncol Biol Phys 1998; 41: 307-17.
- Ho CM, Chien TY, Huang SH, Wu CJ, Shih BY, Chang SC. Multivariate analysis of the prognostic factors and outcomes in early cervical cancer patients undergoing radical hysterectomy. Gynecol Oncol 2004; 93: 458-64.
- Samlal RA, van der Velden J, Ten Kate FJ, Schilthuis MS, Hart AA, Lammes FB. Surgical pathologic factors that predict recurrence in stage IB and IIA cervical carcinoma patients with negative pelvic lymph nodes. Cancer 1997; 80: 1234-40.
- Prempree T, Patanephan V, Sewhand W, Scott RM. The influence of patient’s age and tumor grade on the prognosis of carcinoma of the cervix. Cancer 1983; 51: 1764-71.
- Stanhope CR, Smith JP, Wharton JT, Rutledge FN, Fletcher GH, Gallager HS. Carcinoma of the cervix: the effect of age on survival. Gynecol Oncol 1980; 10: 188-93.
- van der Graff Y, Peer PGM, Ziclhuis GA, Vooijs PG. Cervical cancer survival in Nijmegan region, The Netherlands, 1970-1985. Gynecol Oncol 1988; 30: 51-56.
- Meanwell CA, Kelly KA, Wilson S, Roginski C, Woodman C, Griffiths R, Blackledge G. Young age as a prognostic factor in cervical cancer: analysis of population based data from 10,022 cases. Br Med J (Clin Res Ed). 1988 6; 296: 386-91.
- Sigurdsson K, Hrafnkelsson J, Geirsson G, Gudmundsson J, Salvarsdóttir A. Screening as a prognostic factor in cervical cancer: analysis of survival and prognostic factors based on Icelandic population data, 1964-1988. Gynecol Oncol 1991 ; 43: 64-70.
- Lai CH, Hong JH, Hsueh S, Ng KK, Chang TC, Tseng CJ, Chou HH, Huang KG. Preoperative prognostic variables and the impact of postoperative adjuvant therapy on the outcomes of Stage IB or II cervical carcinoma patients with or without pelvic lymph node metastases: an analysis of 891 cases. Cancer. 1999; 85: 1537-46.
- Paley PJ, Goff BA, Minudri R, Greer BE, Tamimi HK, Koh WJ. The prognostic significance of radiation dose and residual tumor in the treatment of barrel- shaped endophytic cervical carcinoma. Gynecol Oncol 2000; 76: 373-9.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 23 Aralık 2010 |
| Yayımlandığı Sayı | Yıl 2010Cilt: 32 Sayı: 4 |