Porgnostic Value of Tumor Size in Surgically Treated Carcinoma of the Cervix Uteri FIGO Stage II

Objectives: Tumor size is a well recognised prognostic factor in early stage cervical carcinoma (CX). But, limited knowledge exists about the value of timor size in surgically treated CX with extrauterine extension.

Methods: 245 cases of local advanced CX (FIGO stage IIA and IIB) who received upfront surgery, were evaluated regarding tumor size, regarding the prediction of pelvic lymph node involvement, recurrence free and overall survival during a median follow-up time of 54 months (95%-CI 45.4–62.6 months). Tumors larger than 4cm were defined as bulky stage disease.

Results: Bulky disease was seen in 46.1% (113/245). 60.2% of these patients showed pelvic lymph node involvement, compared to 42.4% (56/132) in non-bulky tumors (p=0.006; odds ratio: 2.2 [95% CI: 1.3–3.6]). Patients with bulky tumors showed an increase of recurrent disease (40.2% vs. 28.0%; p=0.045). The relative risk for recurrent disease was 1.97 (95%-CI: 1.3–3.0). The 5-year overall survival rate was significant lower (67.7% [95% CI: 58.2–74.8] vs. 49.5% [95% CI: 36.8–59.1]; p=0.0015).

In multivariate analysis, tumor stage, pelvic lymph node involvement and maximal tumor size, were independent prognostic factors.

Conclusions: The results suggest that tumor size, defining bulky disease as tumors larger than 4cm, is of prognostic impact also in FIGO stage II cervical carcinomas. A revised FIGO/TNM classification system similar to the subgrouping of stage IB CX is recommended for stage II using a cut-off value of 4cm as discriminator: stage IIA1 and stage IIB1 for tumors with < 4cm and IIA2 and IIB2 for tumors >4cm (i.e. bulky disease).

cervical carcinoma - tumor-size-measurement - FIGO stage II - advanced disease - bulky disease