Abstract
BackgroundTo evaluate whether tumor invasion depth can be a reliable and easily applicable pathologic assessment strategy to predict outcomes using surgically resected cervical squamous cell carcinoma specimens from patients who have received neoadjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT).MethodsWe included 173 patients with cervical squamous cell carcinoma who received neoadjuvant CCRT (n = 125) or RT (n = 48) and underwent subsequent radical hysterectomy. Data for the pre-operative clinical International Federation of Gynecology and Obstetrics (FIGO) stage, post-operative pathologic FIGO stage, World Health Organization (WHO) double diameter measurement evaluation, response evaluation criteria in solid tumors (RECIST 1.1) criteria, tumor necrosis rate (TNR), and tumor regression grade (TRG) were investigated to identify correlations with outcomes related to distant metastasis and survival. The tumor invasion depth (TID) and the tumor invasion depth with cytokeratin immunostaining correction (TIDC) at the cervical internal surface were measured to assess their relations to patients’ outcomes.ResultsBased on measurements taken via transvaginal ultrasound, the pre-operative clinical and post-operative pathologic FIGO staging as well as the WHO double diameter measurement evaluation and RECIST 1.1 criteria were predictive of distant metastasis and survival-related outcomes. Also, lymph node involvement was found to be an independent prognostic factor for recurrence and distant metastasis. Finally, univariate analysis showed both the TID and TIDC were highly related to distant metastasis, overall survival, and progression-free survival, irrespective of the clinical stage of carcinomas.ConclusionThe TID or TIDC measured at the cervical internal surface is a useful and easily applied pathologic prognostic factor for distant metastasis and survival outcomes in patients with cervical squamous cell carcinoma treated with neoadjuvant RT or CCRT.Electronic supplementary materialThe online version of this article (doi:10.1186/s13000-015-0426-6) contains supplementary material, which is available to authorized users.
Highlights
To evaluate whether tumor invasion depth can be a reliable and applicable pathologic assessment strategy to predict outcomes using surgically resected cervical squamous cell carcinoma specimens from patients who have received neoadjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT)
Just as we have observed in our clinical practice, previous studies have confirmed that even Federation of Gynecology and Obstetrics (FIGO) stage III b cervical carcinoma patients who receive neoadjuvant therapies are able to endure surgical treatment with better outcomes [9,10,11]
The results showed that distant metastasis and death occurred more frequently among patients who experienced Partial response (PR) compared to Complete response (CR), (P < 0.05 for World Health Organization (WHO) double diameter measurement and the response evaluation criteria in solid tumors (RECIST) 1.1 evaluation)
Summary
To evaluate whether tumor invasion depth can be a reliable and applicable pathologic assessment strategy to predict outcomes using surgically resected cervical squamous cell carcinoma specimens from patients who have received neoadjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT). Cervical squamous cell carcinoma is one of the most common gynecological malignancies, affecting the health of women worldwide [1, 2]. Just as we have observed in our clinical practice, previous studies have confirmed that even FIGO stage III b cervical carcinoma patients who receive neoadjuvant therapies are able to endure surgical treatment with better outcomes [9,10,11]. The use of neoadjuvant radiotherapy (RT) alone or with concomitant chemoradiotherapy (CCRT) is effective for achieving excellent cervical carcinoma control along with surgical resection [12, 13]
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