Prognostic factors for risk of recurrence in stages Ib and IIa cervical cancer.

The following factors can be clearly identified as independent risk factors for an increased incidence of recurrence and decreased survival in patients with early (Stages Ib and IIa) cervical cancer: 1. Nodal metastases (a) multiple nodes or node groups (b) bilateral nodes or node groups 2. Size of tumour equal to, or greater than, 4 cm 3. Depth of invasion into the cervix equal to, or greater than, 10 mm, or invasion into the outer one-third of the cervix Risk factors which may be important but which are not clearly established as being independent of other factors are: 1. Histological cell type 2. Histological grade 3. Lymphovascular invasion 4. Extension to the corpus uteri 5. Age of the patient at diagnosis 6. Stage IIa It is thus clear that patients with nodal metastases, patients who have large primary tumours, and patients with deep invasion into the cervix should be identified for prospective randomized trials of adjunctive therapy. On the basis of non-randomized historical data, one could legitimately question the value of pelvic irradiation alone in these patients. Recent reports of the use of adjunctive chemotherapy administered preoperatively (Kim et al, 1988) or of adjunctive chemotherapy and radiotherapy administered postoperatively (Wertheim et al, 1985) indicate possible avenues for further investigation.