Analysis Of Prognosis Related Factors With Cervical Squamous Cell Carcinoma Of Stage IB And ⅡA

Cervical cancer is the most common gynecologic malignant disease. There are 371,000 new patients with cervical cancer and 190,000 dead of the disease each year. Cervical cancer has been the second dead cause in women, 78% of those were in developing countries. It menaces the health of women severely. Surgery is the first choice of treatment to early stage cervical cancer. The standard treatment of stage IB and IIA cervical cancer is radical surgery, including radical hysterectomy and bilateral lymphadenectomy. If the patient confirmed to have one or more than one high risk pathologic factors, she needs to be followed by adjuvant treatment (radiotherapy, chemotherapy or both). Most of them will recover after surgery or surgery and adjuvant treatment, but it still has the mortality about 20%, and it has not been changed in late 20 years. High risk factors are including poor differentiation, positive lymph node, deep stromal invasion, parametrical extension, tumor size≥ 4cm, and lymph vascular space involvement, positive vaginal margin. The high risk factors are the reason of pelvic local recurrent and/or faraway metastasis, andsurvival decrease after treatment. But there is much controvercy about these prognosis factors. In addition, each prognosis factor can influence the prognosis of early stage cervical cancer, but it has different degree, and maybe has the inflence of other kinds of factors.Recent studies have established all kinds of prognosis-predicting systems of early stage cervical cancer on the base of analysis of prognosis factors. But the prognosis-predicting system has not been recognised as prognostic grading system of trophoblastic tumor. And the patten of surgery in inland is distinguished with that of Taiwan of China and other countries. This study will try to discuss the relationship of high risk factors and survival, and plan to establish a prognosis-predicting system based on high risk factors. We expect for establishing prognosis-predicting system in cervical cancers, which can guide available adjuvant therapy after surgery individually.The controvercy about the value of clinical and pathlogical factors is lack of standard index and lack of repeatability in practice. In recent years along with the developing of imunnology and biology of cervical cancer, it is more and more important of using biologic index to determine the prognosis of cervical cancer. The enzyme Cyclooxygenase (COX) is a responsible for the conversion of arachidonic acid to prostaglandins. COX have COX-1 and COX-2 two subtypes. Recent studies found COX-2 had an important role in tumor regenesis, development and prognosis. Most of studies showed COX-2 expression was a strong indicator of unfavorable prognosis. But few studies found COX-2 expression and prognosis of cervical cancer were not related.This study plans to retrospective analysis of clinicalpathlogical data of stage IB and IIA cervical squamous cell cancer received by surgery, and to analyse the probable inflence prgnostic factors. And we also plan to establish prognosis-priditing system of early stage squamous cervical cancer. It may be an assistant to guiding an available adjuvant therapy after surgery and proceeding survival condition. We simultaneously use COX-2 immunohistochemical assay to detect cervical tissue, to invetigate the relastionship of COX-2 expression and prognosis of cervical cancer patients.I. Establishment of prognosis-predicting system with cervical squamous cell carcinoma of stage IB and IIA undergoing radical hysterectomyObjective: To analyze the prognostic factors in patients with cervical squamous cell carcinoma stage IB and IIA treated by surgery, and investigate their guide role in available post-operation adjuvant therapy. Methods: A total of 10 clinicopathologic parameters of 306 patients with stage IB and IIA cervical squamous cell carcinoma, who underwent radical hysterectomy and pelvic lymphadenectomy, were retrospectively recorded and analyzed by univariate and multivariate methods. Independent prognostic factors were identified by COX-2 proportional hazards regression model. Results: The overall 5-year survival rate of the 306 patients was 78.1%. In univariate survival analysis, the poor prognostic factors included poor differentiation, positive lymph node, deep stromal invasion, parametrical extension, tumor size ^ 4cm, and lymph vascular space involvement (p<0.05), while in multivariate survival analysis, the independent prognostic factors included positive lymph node, deep stromal invasion and parametrical extension (p<0.05). All the patients were divided into low, intermediate and high risk groups with 5-year survival rate of 90.3%, 83.9% and 43.1%, repectively. In low risk group, no risk factor or only parametrical extension was involved, and pelvic recurrence rate was only 2.2%. In intermediate risk group, deep stromal invasion or combining parametrical extension was involved, and pelvic recurrence rate was 13.5%. In high risk group, pelvic recurrence and extra pelvic metastasis rate were 25.9% and 48.3%, respectively. The combined both rate was 10.3%.Conclusions: Lymph node metastasis, deep stromal invasion and parametrical extension were independent prognostic factors with cervical squamous cell carcinoma of stage IB and IIA undergoing radical hysterectomy and lymphodenectomy. The establishment of prognosis-predicting system based on high risk factors may be an assistant to predict the risks of recurrence and metastasis, and guide the available adjuvant therapy after surgery.II. Significance of expression of COX-2 in stage IB and IIA cervical squamous cell carcinoma tissueObjective: To ascertain the possible roles of COX-2 in the tumor regenesis and development of cervical squamous cell cancer.Methods: Immunohistochemical assay (EnVision method) was used to detect COX-2 in all specimens, including 107 cervical squamous cell cancer (FIGO IB, IIA) and 30 normal cervices. Results: The overall positive expression rate of COX-2 in cervical cancer was 55.14%, higher than that in normal cervix (0%). In univariate survival analysis, the intensity of expression of COX-2 in cervical cancers was not related to lymph node metastasis, age, large tumor size and tumor differentiation (P>0.05). Positive COX-2 was related to FIGO stage, deep stromal invasion or lymph vascular space involvement (P<0.05). Survival analysis showed that positive COX-2 expression of cervical cancer cell was not related with patients' 5-year survival.Condusions: Positive COX-2 was related to stage, deep stromal invasion or lymph vascular space involvement, not related to prognosis. So the prognostic value of COX-2 in cervical cancer needs to be verified in the future.