Prognostic effect of different cut-off values (20mm, 30mm and 40mm) for clinical tumor size in FIGO stage IB cervical cancer

Abstract 

Objective

The aim of this study is to evaluate whether applying cut-off values of 20mm, 30mm and 40mm for tumor size have prognostic value in terms of survival or not.

Material and methods

Medical records of 193 patients with FIGO stage IB cervical cancer (IB1: 173, IB2: 20) undergoing radical hysterectomy were evaluated. Tumor size was defined as the greatest tumor diameter determined by rectovaginal examination under general anesthesia. The influence of cut-off values (20mm, 30mm, and 40mm) on surgical-pathologic risk factors and survival rates was evaluated.

Results

Tumor size was ≤20mm in 71, ≤30mm in 125 and ≤40mm in 174 patients. Only 40mm was associated with the presence of metastasis in at least one of pelvic or para-aortic lymph nodes. Depth of stromal invasion was affected by 20mm and 30mm. For parametrial and surgical margin involvement, only 30mm had a statistically significant effect. Probability of receiving adjuvant radiotherapy was similar with all of the cut-off values. Neither cut-off value had a statistically significant effect in terms of survival rates. It was observed that lymph node metastasis and age affected 5-year disease-free survival (DFS) and 5-year overall survival (OS) rates. OS, but not DFS, was affected by lymphovascular space invasion. Stage, cell type, grade, parametrial invasion, presence of tumor at surgical margin and depth of stromal invasion did not affect recurrence or survival rates. Age and pelvic lymph node involvement were independent prognostic factors.

Discussion

The present study did not find a single cut-off value for tumor size that can predict all surgical-pathologic risk factors. Recurrence and survival were not affected by any of these values.

Keywords: Cervical cancer, Tumor size, Surgical-pathologic risk factor, Survival