The aim of this retrospective investigation was to assess the prognostic relevance of some pre-treatment clinical variables and histological findings assessed on the surgical samples of 46 patients with stage Ib(2)-IIb cervical cancer treated with cisplatin-based neoadjuvant chemotherapy followed by radical hysterectomy. Seven patients achieved a pathologically documented complete response, 6 had an optimal partial response, 29 had a suboptimal partial response, and 4 had stable disease. As for histological findings on surgical samples, 7 (15.2%) patients had positive lymph nodes, 10 (21.7%) had lymph-vascular space involvement, and 10 (21.7%) had positive parametria and/ or surgical margins. After surgery, 38 patients received further treatment with chemotherapy and/or irradiation. The median follow-up of survivors was 53 months (range, 4-167 months).Thirteen (28.3%) patients developed recurrent tumour, 11 (23.9%) patients died of tumour and one patient died of ictus with no clinical evidence of tumour. Recurrence-free and overall survival were significantly related to tumour stage (Ib(2)-IIa versus IIb, p=0.01 and p=0.02, respectively), pathologically assessed lymph node status (negative versus positive, p=0.0009 and p=0.007), lymph-vascular space status (negative versus positive, p=0.01 and p=0.009), parametrial and/or surgical margin status (negative versus positive, p=0.0001 and p=0.0005), but not to haemoglobin level before chemotherapy, patient age, tumour grade or chemotherapy regimen. A platelet count before chemotherapy above the median value of 272,000/microl was associated with a trend for a shorter recurrence-free survival (p=0.06) and with a significantly shorter overall survival (p=0.04) when compared with a lower platelet count. In conclusion, FIGO stage, lymph node status, lymph-vascular space status, parametrial and/or surgical margin status and pre-treatment platelet count are predictors of clinical outcome in patients with FIGO stage Ib(2)-IIb cervical cancer undergoing cisplatin-based neoadjuvant chemotherapy followed by radical hysterectomy. A multivariate analysis on a larger series of homogeneously treated patients is warranted to better define the clinicopathological risk factors useful to adequately plan the therapeutic strategy.
CLINICOPATHOLOGICAL VARIABLES PREDICTIVE OF CLINICAL OUTCOME IN PATIENTS WITH FIGO STAGE IB2-IIB CERVICAL CANCER TREATED WITH CISPLATIN-BASED NEOADJUVANT CHEMOTHERAPY FOLLOWED BY RADICAL HYSTERECTOMY
GADDUCCI, ANGIOLO;GENAZZANI, ANDREA
2010-01-01
Abstract
The aim of this retrospective investigation was to assess the prognostic relevance of some pre-treatment clinical variables and histological findings assessed on the surgical samples of 46 patients with stage Ib(2)-IIb cervical cancer treated with cisplatin-based neoadjuvant chemotherapy followed by radical hysterectomy. Seven patients achieved a pathologically documented complete response, 6 had an optimal partial response, 29 had a suboptimal partial response, and 4 had stable disease. As for histological findings on surgical samples, 7 (15.2%) patients had positive lymph nodes, 10 (21.7%) had lymph-vascular space involvement, and 10 (21.7%) had positive parametria and/ or surgical margins. After surgery, 38 patients received further treatment with chemotherapy and/or irradiation. The median follow-up of survivors was 53 months (range, 4-167 months).Thirteen (28.3%) patients developed recurrent tumour, 11 (23.9%) patients died of tumour and one patient died of ictus with no clinical evidence of tumour. Recurrence-free and overall survival were significantly related to tumour stage (Ib(2)-IIa versus IIb, p=0.01 and p=0.02, respectively), pathologically assessed lymph node status (negative versus positive, p=0.0009 and p=0.007), lymph-vascular space status (negative versus positive, p=0.01 and p=0.009), parametrial and/or surgical margin status (negative versus positive, p=0.0001 and p=0.0005), but not to haemoglobin level before chemotherapy, patient age, tumour grade or chemotherapy regimen. A platelet count before chemotherapy above the median value of 272,000/microl was associated with a trend for a shorter recurrence-free survival (p=0.06) and with a significantly shorter overall survival (p=0.04) when compared with a lower platelet count. In conclusion, FIGO stage, lymph node status, lymph-vascular space status, parametrial and/or surgical margin status and pre-treatment platelet count are predictors of clinical outcome in patients with FIGO stage Ib(2)-IIb cervical cancer undergoing cisplatin-based neoadjuvant chemotherapy followed by radical hysterectomy. A multivariate analysis on a larger series of homogeneously treated patients is warranted to better define the clinicopathological risk factors useful to adequately plan the therapeutic strategy.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
