Prognostic factors in surgically treated stage ib-iib cervical carcinomas with special emphasis on the importance of tumor volume

OBJECTIVE

The aim of the study was to analyze the importance of tumor volume as a prognostic factor for overall survival (OS) in surgically treated stage Ib-IIb cervical carcinoma.

METHODS

One hundred thirteen of one hundred sixty-five patients with histopathological stage Ib-IIb cervical carcinoma (44 Ib1, 24 Ib2, 10 IIa, 35 IIb) treated by radical abdominal hysterectomy between 1989 and 1999, for whom tumor volume could be assessed, were included in this study. Of the 113 patients, 90 (79.6%) received postoperative radiotherapy. Measurement of tumor volume was performed on giant histological sections using a semiautomatic image analyzer. The prognostic significance of tumor volume was analyzed and compared with that of various clinicopathological parameters using uni- and multivariate statistics.

RESULTS

The 5-year disease-free survival was 71.4%. Increasing tumor volume was associated with more frequent lymph node metastases and a significant decrease in OS (P = 0.0112). The Median tumor volume was smaller in stage IIa tumors than in stage Ib2 tumors, and histopathological stage did not correlate linearly with lymph node metastases as well as OS. Stage Ib2 tumors were associated with worse overall survival than stage IIa tumors. In univariate analysis, lymph node metastases, histopathological stage, lymph vascular space involvement, tumor volume, parametrial spread, and tumor involvement of resection margins were significant parameters for OS. In multivariate statistical analysis, only lymph node metastases and histopathological staging remained independent prognostic factors for OS.

CONCLUSIONS

Tumor volume does not seem to confer additional prognostic information if histopathological stage and lymph node status are known. However, it may provide important prognostic information if lymph node status is not known or histopathological stage cannot be assessed.

Quantification of thermal asymmetry. Part 1: Normal values and reproducibility

The use of thermography in evaluating nerve injury is based on the presence of temperature asymmetries between the involved area of innervation and the corresponding area on the opposite side of the body. However, interpretation of the thermographic image has been troubled by subjectivity. This paper describes a computer-calculated method of collecting data that eliminates subjective biases. Comprehensive normative data are presented on the degree of thermal asymmetry in the human body. The degree of thermal asymmetry between opposite sides of the body (delta T) is very small. For example, the value of delta T for the forehead (mean +/- standard deviation) was 0.18 degree +/- 0.18 degree C, for the leg it was 0.27 degree +/- 0.2 degree C, and for the foot it was 0.38 degree +/- 0.31 degree C. These values were reproducible in both short- and long-term follow-up measurements over a period of 5 years. The delta T's reported here were obtained from 40 matched regions of the body surface of 90 asymptomatic normal individuals. These values can be used as a standard in assessment of sympathetic nerve function, and the degree of asymmetry is a quantifiable indicator of dysfunction.