Objectives:
The aim of this study was to report on the interrelation of various histopathologic prognostic factors and their effect on tumour spread and metastatic patterns following curative resection of primary tumour in cervix and endometrial cancer patients.
Methods and Materials:
One thousand four hundred and twenty seven cervix and endometrial cancer patients who were treated with surgery and adjuvant radiotherapy were retrospectively analysed. Follow-up consisted of periodical physical examination. Symptomatic patients and those deemed to be at high risk of recurrence were investigated with CT, PET/CT and/or biopsy as appropriate. Cox proportional hazards regression model and conditional logistic regression model were constructed to look at the interdependence of various prognostic factors and their relationship with survival, patterns of metastases and time to metastases in pelvis, para-aortic and distant sites.
Results:
Nineteen percent patients had developed metastases over a median period of 5.4 years. Pelvic, para-aortic and distant metastases were observed in 13%, 11% and 8.5% respectively. Lymphovascular space invasion (LVSI) emerged as the most important prognostic factor for relapse and survival. Tumour size did not relate either to LVSI or survival. The incidence of metastases progressively increased in presence of LVSI and increasing stations of nodal involvement at the time of primary surgery. Tumour size in absence of LVSI had no effects on distant metastasis. Rate of development of metastases varied with the disease extent and was not sequential.
Conclusion:
LVSI emerged as the most important prognostic factor for development of lymphnode and distant metastases. In the absence of LVSI, the incidence of distant metastases was low irrespective of tumour size. In the clinical situation studied here, the process of metastases appeared to favour LVSI and inter-tissular lymphatico-venous anastomotic path rather than through direct tumour blood vessels.