TITLE:
Survival and Prognostic Factors in Patients with Carcinoma of Cervical Stump
AUTHORS:
Hanan Ahmed Wahba, Hend Ahmed El-Hadaad, Waleed Nabeel Abozeed, Waleed Elnahas, Sameh Roshdy, Anas Gamal
KEYWORDS:
Carcinoma of Cervical Stump, Chemo-Radiotherapy, Radiotherapy, Survival and Prognostic Factors
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.6 No.11,
October
29,
2015
ABSTRACT: Purpose: To evaluate patients with carcinoma of cervical stump (CCS) and
analyse different clinico-pathologic factors affect prognosis. Patients and Methods:
This study was carried out through review of clinical records of patients.
Recorded data included information on age, tumor stage, presenting symptoms,
size of tumor, histopathology, grade, type, cause of subtotal hysterectomy
(STH), treatment and follow-up results. Staging according to International
Federation of Gynecology and Obstetrics (FIGO) staging system was done through:
PHYSICAL examination, pelvic examination under anaesthesia, chest X-ray,
magnetic resonance imaging (MRI) of the abdomen and pelvis, cystoscopy,
rectosigmoidoscopy and intravenous pyelography. Prognostic factors as age, size
of tumor, stage, lymph node (LN) involvement, pathological type, grade and type
of CCS either true or coincidental were analysed through multivariate analysis.
Results: 62% of patients are above 50 years with stage II in 48.7%. Squamous
cell carcinoma was more common but 54% are of GIII. 89% were true CCS. Positive
lymph nodes were reported in 27%. The predominant reason for STH was abnormal
bleeding (73%). In about 95% of cases, women seeked medical attention because
of symptoms and the most common presenting symptom was bleeding (54%).
According to the stage and performance status of patients, treatment consisted
of radiotherapy either external or interstitial, chemotherapy and
chemoradiotherapy. Through multivariate analysis, the following was found to
have adverse impact on survival: Coincidental type (P = 0.04), high grade (P = 0.03),
advanced stage (P = 0.01), larger tumor size (P = 0.02), lymph node involvement
(P = 0.029) and older age (P = 0.035). While pathological type was not (P = 0.52).
After median follow-up of 52 months; 5-year overall survival was 65%.
Conclusion: CCS has a low morbidity. Adverse survival outcomes can be
anticipated in those patients with: high grade lesions, advanced stages, large
tumor size, coincidental type, older age and positive lymph node involvement.