Adenocarcinoma of the uterine cervix: prognostic significance of clinicopathologic parameters, flow cytometry analysis and HPV infection.

BACKGROUND: This study was designed to determine the possible impact of status of human papillomavirus (HPV) infection (no infection, single, multiple infections) on the survival of patients with cervical adenocarcinoma, to correlate the HPV status with other clinicopathologic parameters, and to examine clinical, histological and flow cytometric parameters as predictors of survival in cervical adenocarcinoma. METHODS: The clinical data of 51 patients with adenocarcinoma of the cervix who were treated at the Department of Gynecology and Obstetrics, Zagreb University School of Medicine, from 1978 to 2004 were analysed: age at presentation, menstrual status, clinical stage, relapse, survival. Exact histologic subtype, architectural grade and nuclear grade were determined. DNA flow cytometry was performed to determine DNA ploidy and proliferative index. Polymerase chain reaction (SPF primers), followed by reverse hybridisation for genotyping, was used to determine the HPV status. RESULTS: The status of HPV infection had no impact on patient survival, and could not be correlated with any of the analysed clinicopathologic parameters. Univariate analysis showed significant association between patient survival and clinical stage (p=0.002) and architectural grade (p=0.033). Multivariate analysis confirmed both parameters as significantly associated with survival. Menstrual status, nuclear grade, DNA ploidy and proliferative activity had no impact on patient survival. CONCLUSION: Clinical stage and architectural grade are significant predictors for survival of patients with cervical adenocarcinoma. Status of HPV infection, flow cytometric parameters, nuclear grade and menstrual status do not predict patient survival.

Adenocarcinoma of uterine cervix -- prognostic significance of clinicopathologic parameters.

AIM: To investigate prognostic significance of several clinicopathologic parameters in patients with adenocarcinoma of the uterine cervix. METHODS: We retrospectively studied 36 patients treated at the Department of Gynecology and Obstetrics, Zagreb University School of Medicine, Croatia, in the period from 1978-1998. Cox proportional hazard analysis was performed to examine the prognostic significance of menstrual status, clinical stage, architectural grade, nuclear grade, DNA ploidy, proliferative activity, and mode of therapy. RESULTS: The 5-year survival for this group of patients was 75%. The following parameters proved to be statistically significant in a univariate analysis: clinical stage (P=0.042), architectural grade (P=0.009), and nuclear grade (P=0.002). In the multivariate analysis, the nuclear grade (P=0.007) turned out to be the only statistically significant parameter. According to the nuclear grade, the five-year survival was 80% in the prognostically favorable and only 30% in the unfavorable group of patients. CONCLUSION: Our data showed that in patients with adenocarcinoma of the uterine cervix the nuclear grade, clinical stage, and architectural grade of the tumor represent the most important prognostic parameters. The analysis of DNA ploidy and proliferative activity had no prognostic significance.

Invasive squamous cell carcinoma of vulva: prognostic significance of clinicopathologic parameters.

AIM: To investigate the prognostic significance of several clinicopathologic parameters in patients with invasive squamous cell carcinoma of the vulva. METHODS: We retrospectively studied 43 patients with invasive squamous cell carcinoma of the vulva treated with radical vulvectomy at the Department of Gynecology and Obstetrics at Zagreb University School of Medicine, Croatia, in the period from 1978-1996. At the time of analysis, follow-up information was obtained for all patients, 18 (41.9%) of whom have died and 25 (58.1%) who were alive at the time of the last contact. The mean follow-up time of surviving patients was 121 months (range, 6-216 months). Cox proportional hazard analysis was performed to examine the prognostic significance of age, menstrual status, clinical stage, diameter and localization of the tumor, histological grade, nuclear grade, depth of tumor invasion, presence of vascular space invasion, tumor growth pattern, presence of lymph node metastasis, DNA ploidy, proliferative activity, and mode of therapy. RESULTS: The overall 5-year survival for this group of patients was 62.3%. The results of univariate statistical analysis confirmed that statistically significant prognostic parameters included the age of patients (P=0.038), clinical stage (P=0.001), nuclear grade (P=0.002), the depth of tumor invasion (P<0.001), and presence of lymph node metastasis (P=0.001). On the other hand, the results of multivariate statistical analysis showed that only the depth of tumor invasion (P<0.001) can be considered independent, statistically significant prognostic parameter. CONCLUSION: Our data suggest that the depth of tumor invasion represents the most important prognostic parameter in the group of patients with invasive squamous vulvar carcinoma. Clinical significance of DNA ploidy and proliferative activity was not found.