Prognosis and prognostic factors in node-negative cervix cancer

Relapse rates, mortality rates and possible prognostic factors were assessed in women with early-stage, node-negative cervix cancer. We identified 194 women who had a radical hysterectomy with histopathologically confirmed negative lymph nodes as primary treatment for FIGO stages IB and IIA cervix cancer between 1981 and 1990, at a single tertiary referral oncology centre. Each patient’s pathology was reviewed by two pathologists blinded to patient outcome. Clinical and demographic details were abstracted from medical records by a single observer blinded to patient outcome. Median follow-up was 5.3 years and 95% were followed for longer than 2 years. Prognostic significance for relapse-free survival was assessed with Cox’s proportional hazards model. There were 27 relapses (relapse-free survival probability of 85% (95% confidence interval (CI): 79–90)) and 19 deaths (overall survival probability 86% (95% CI: 78–93)), of which 17 were due to cervix cancer (cervix cancer specific survival probability 87% (95% CI: 80–94)). Nuclear grade 2 or 3 (P = 0.02) and small-cell squamous histology (P = 0.01) were each associated with about a four-fold increase in the risk of recurrence, while lymphatic permeation (P = 0.02), age less than 36 years (P = 0.03) and either tumor size> 28 mm (P = 0.03) or surgical clearance < 5 mm (P = 0.02) were each associated with about a 2.5-fold increase in the risk of recurrence. Adverse histologic features, young age and large tumor size were independent predictors of increased recurrence rates in these women with early-stage cervix cancer.