Horn L-C, Fischer U, Raptis G, Bilek K, Hentschel B
Institute of Pathology, Division of Gynecologic Pathology, University Leipzig, Liebigstrasse 26, Leipzig, D-04103, Germany.
Gynecol Oncol. 2007 Nov;107(2):310-5. doi: 10.1016/j.ygyno.2007.06.026. Epub 2007 Sep 12.
Tumor size is a well recognized prognostic factor in early stage cervical carcinoma (CX). However, limited knowledge exists about the value of tumor size in surgically treated CX with extrauterine extension.
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 and recurrence free and overall survival during a median follow-up time of 54 months (95% CI 45.4-62.6 months). Tumors larger than 4 cm were defined as bulky stage disease.
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 significantly 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.
The results suggest that tumor size, defining bulky disease as tumors larger than 4 cm, 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 4 cm as discriminator: stage IIA1 and stage IIB1 for tumors with </=4 cm and IIA2 and IIB2 for tumors >4 cm (i.e. bulky disease).
肿瘤大小是早期宫颈癌（CX）公认的预后因素。然而，对于有子宫外扩展的手术治疗的CX患者，肿瘤大小的价值所知有限。
对245例接受 upfront 手术的局部晚期CX（国际妇产科联盟（FIGO）分期IIA和IIB）患者的肿瘤大小进行评估，以预测盆腔淋巴结受累情况以及在中位随访时间54个月（95%置信区间45.4 - 62.6个月）内的无复发生存率和总生存率。肿瘤大于4 cm被定义为大块疾病期。
46.1%（113/245）的患者为大块疾病期。这些患者中有60.2%出现盆腔淋巴结受累，而非大块肿瘤患者的这一比例为42.4%（56/132）（p = 0.006；优势比：2.2 [95%置信区间：1.3 - 3.6]）。大块肿瘤患者的复发疾病有所增加（40.2%对28.0%；p = 0.045）。复发疾病的相对风险为1.97（95%置信区间：1.3 - 3.0）。5年总生存率显著更低（67.7% [95%置信区间：58.2 - 74.8]对49.5% [95%置信区间：36.8 - 59.1]；p = 0.0015）。在多变量分析中，肿瘤分期、盆腔淋巴结受累情况和最大肿瘤大小是独立的预后因素。
结果表明，将肿瘤大小大于4 cm定义为大块疾病时，肿瘤大小在FIGO II期宫颈癌中也具有预后影响。建议采用与FIGO/TNM分类系统类似的修订分类系统，对于II期，以4 cm为临界值进行亚组划分：肿瘤≤4 cm为IIA1期和IIB1期，肿瘤>4 cm（即大块疾病）为IIA2期和IIB2期。
