Identification of histopathologic risk groups in stage IB squamous cell carcinoma of the cervix

This study was undertaken to identify histopathologic risk factors in 100 women with stage IB squamous cell carcinoma of the cervix treated surgically. Histologic factors included maximum depth of stromal invasion, presence of lymphvascular invasion, mitotic activity, nature of the tumorstromal borders, plasma cell-lymphocyte stromal response, histologic grade, and metastases to regional lymph nodes. Using a multifactorial analysis, the maximum depth of stromal invasion was found to be the most important prognostic indicator (P<.0001). The depth of invasion also correlated significantly with the presence of nodal metastases (P <.0001), lymph-vascular space invasion (P=.0003), and "spreading" versus "pushing" borders (P=.0315). The number of mitoses, grade of tumor, or plasma cell-lymphocyte stromal response did not correlate significantly with depth of stromal invasion. Lymph-vascular involvement, although present in 59% of the patients, did not significantly affect survival. Depth of stromal invasion and lesion diameter were combined to constitute three risk groups: 1) Patients with small size cervical rumors (less than 2 cm), regardless of depth of stromal invasion, as well as patients with intermediate size lesions (2.1 to 3 cm) with stromal invasion less than or equal to 1.5 cm, constituted a low-risk group; 2) the intermediate-risk group was comprised of those patients with cervical lesions between 2.1 and 3 cm in size and deep stromal invasion (greater than 1.5 cm), as well as those patients with large cervical lesions (greater than 3.0 cm) and stromal invasion less than or equal to 1.5 cm; and 3) the high-risk group consisted of patients with large size cervical lesions (greater than 3 cm) and deep stromal invasion greater than 1.5 cm). The five-year survival rates of the risk groups were 97, 71, and 31%, respectively. When considered within these risk categories, pelvic node metastases and lymph-vascular space involvement have less prognostic significance.