Lesion Size Lesion size is an independent predictor of survival. Patients with lesions smaller than 2 cm have a survival rate of approximately 90%, and patients with lesions larger than 2 cm have a 60% survival rate (89). When the primary tumor is larger than 4 cm, the survival rate drops to 40% (87,97). An analysis of a Gynecologic Oncology Group (GOG) prospective study of 645 patients showed a 94.6% 3-year disease-free survival rate for patients with occult lesions, 85.5% for those with tumors smaller than 3 cm, and 68.4% for patients with tumors larger than 3 cm (98).
Depth of Invasion Patients in whom depth of invasion is less than 1 cm have a 5-year survival rate of approximately 90%, but the survival rate falls to 63% to 78% if the depth of invasion is more than 1 cm (76,98,102–105).
Parametrial Spread Patients with spread to the parametrium have a 5-year survival rate of 69%, compared with 95% when the parametrium is negative. When the parametrium is involved and pelvic lymph nodes are positive, the 5-year survival rate falls to 39% to 42% (90,106).
Lymph–Vascular Space Involvement The significance of finding lymph–vascular space involvement is somewhat controversial. Several reports show a 50% to 70% 5-year survival rate when lymph–vascular space invasion is present and a 90% 5-year survival rate when invasion is absent (76,89,93,107,108). Others found no significant difference in survival if the study is controlled for other risk factors (98,99,109–112). Lymph–vascular space involvement may be a predictor of lymph node metastasis and not an independent predictor of survival.
Lymph Nodes The variable that is most independently predictive of survival is the status of the lymph nodes. Patients with negative nodes have an 85% to 90% 5-year survival rate, whereas the survival rate for those with positive nodes ranges from 20% to 74%, depending on the number of nodes involved and the location and size of the metastases (94–96,99,102,105,111–113).
Data on lymph node status is summarized as follows: 1.
When the common iliac lymph nodes are positive, the 5-year survival rate is about 25%, compared with about 65% when only the pelvic lymph nodes are involved (106,114,115).
2.
Bilateral positive pelvic lymph nodes portend a less favorable prognosis (22% to 40% survival rate) than unilateral positive pelvic nodes (59% to 70%) (114,115).
3.
The presence of more than three positive pelvic lymph nodes is accompanied by a 68% recurrence rate, compared with 30% to 50% when three or fewer lymph nodes are positive (94,112).
4.
Patients in whom tumor emboli are the only findings in the pelvic lymph node have an 82.5% 5-year survival rate, whereas the survival rate is 62.1% and 54% with microscopic invasion and macroscopic disease, respectively (84).
Given the high risk of recurrent disease in surgically treated patients with early-stage cervical cancer who exhibit intermediate-or high-risk pathologic factors, adjuvant radiation or chemoradiation therapy should be considered.