Intensity of cervical inflammatory reaction as a risk factor for recurrence of carcinoma of the uterine cervix in stages IB and IIA
Keywords:
Uterine cervical neoplasms, Recurrence, Survival, Inflammation, Lymphatic metastasis, Neoplasm invasivenessAbstract
CONTEXT AND OBJECTIVE: Infl ammatory reaction intensity has been indicated as a possible recurrence risk factor in carcinoma of the uterine cervix. Some authors observed greater risk with weak infl ammatory reaction, while others described the opposite. This study aimed to evaluate risk factors for initial-stage uterine cervix carcinoma recurrence (IB and IIA), considering infl ammatory reaction intensity. DESIGN AND SETTING: Retrospective cohort at Hospital do Câncer A. C. Camargo. METHODS: 289 patients with diagnosed uterine cervix carcinoma (stages IB and IIA) who underwent radical surgery between 1980 and 1999 were studied. Data were collected from medical records. Histological sections from tumors and lymph nodes could be reviewed in 247 cases. Five-year disease-free survival rates were calculated using the Kaplan-Meier method and curves were compared using the log-rank test. Cox’s proportional-hazards model was used for multivariate analysis. Recurrence risk was estimated using hazard ratios (HR). RESULTS: Forty-three recurrences were found. Multivariate analysis identifi ed the following independent recurrence risk factors: number of metastatic pelvic lymph nodes (one lymph node: HR = 3.3 [1.3-8.3]; two or three: HR = 5.3 [1.5- 18.6]; four or more: HR = 7.6 [1.7-33.2]), tumor invasion depth (deepest third: HR = 2.1 [1.1-4.1]) and infl ammatory reaction intensity in the uterine cervix (absent or slight: HR = 2.5 [1.1-5.7]). CONCLUSION: This study identifi ed that absent or slight infl ammatory reaction was an independent risk factor for recurrence. The other risk factors were the number of metastatic pelvic lymph nodes and invasion of the deepest third of the uterine cervix.
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