DOI QR코드

DOI QR Code

Prognostic Value of Pathological Characteristics of Invasive Margins in Early-stage Squamous Cell Carcinomas of the Uterine Cervix

  • Khunamornpong, Surapan (Department of Pathology, Faculty of Medicine, Chiang Mai University) ;
  • Settakorn, Jongkolnee (Department of Pathology, Faculty of Medicine, Chiang Mai University) ;
  • Sukpan, Kornkanok (Department of Pathology, Faculty of Medicine, Chiang Mai University) ;
  • Suprasert, Prapaporn (Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University) ;
  • Lekawanvijit, Suree (Department of Pathology, Faculty of Medicine, Chiang Mai University) ;
  • Siriaunkgul, Sumalee (Department of Pathology, Faculty of Medicine, Chiang Mai University)
  • Published : 2013.09.30

Abstract

Background: To evaluate the pathological characteristics of invasive margins in early-stage cervical squamous cell carcinomas and their association with other clinicopathological features including clinical outcomes. Materials and Methods: Patients with FIGO stage IB-IIA cervical squamous cell carcinomas who received surgical treatment and had available follow-up information were identified. Their histological slides were reviewed for prognostic variables including tumor size, grade, extent of invasion, lymphovascular invasion, involvement of vaginal margin or parametrium, and lymph node metastasis. The characteristics of invasive margins including invasive pattern (closed, finger-like, or spray-like type), degree of stromal desmoplasia, and degree of peritumoral inflammatory reaction were evaluated along the entire invasive fronts of tumours. Associations between the characteristics of invasive margins and other clinicopathological variables and disease-free survival were assessed. Results: A total of 190 patients were included in the study with a median follow-up duration of 73 months. Tumour recurrence was observed in 18 patients (9%). Spray-like invasive pattern was significantly more associated as compared with closed or finger-like invasive pattern (p=0.005), whereas the degree of stromal desmoplasia or peritumoral inflammatory reaction was not. Low degree of peritumoral inflammatory reaction appeared linked with lymph node metastasis (p=0.021). In multivariate analysis, a spray-like invasive pattern was independently associated with marked stromal desmoplasia (p=0.013), whilst marked desmoplasia was also independently associated with low inflammatory reactions (p=0.009). Furthermore, low inflammatory reactions were independently associated with positive margins (p=0.022) and lymphovascular invasion (p=0.034). The patients with spray-like invasive pattern had a significantly lower disease-free survival compared with those with closed or finger-like pattern (p=0.004). Conclusions: There is a complex interaction between cancer tissue at the invasive margin and changes in surrounding stroma. A spray-like invasive pattern has a prognostic value in patients with early-stage cervical squamous cell carcinoma.

Keywords

Cervical cancer;squamous cell carcinoma;prognosis;invasive pattern;stromal reaction

References

  1. Benatar T, Cao MY, Lee Y, et al (2010). IL-17E, a proinflammatory cytokine, has antitumor efficacy against several tumor types in vivo. Cancer Immunol Immunother, 59, 805-17. https://doi.org/10.1007/s00262-009-0802-8
  2. Bryne M, Boysen M, Alfsen CG, et al (1998). The invasive front of carcinomas. The most important area for tumour prognosis? Anticancer Res, 18, 4757-64.
  3. Chao HT, Wang PH, Tseng JY, et al (1999). Lymphocyteinfiltrated FIGO Stage IIB squamous cell carcinoma of the cervix is a prominent factor for disease-free survival. Eur J Gynaecol Oncol, 20, 136-40.
  4. Eggen T, Arnes M, Moe B, et al (2007). Prognosis of early cervical cancer (FIGO Stages IA2, IB, and IIA) in northern Norway predicted by malignancy grading score and objective morphometric image analysis. Int J Gynecol Pathol, 26, 447-56. https://doi.org/10.1097/pgp.0b013e3180341111
  5. Horn LC, Richter CE, Hentschel B, et al (2006b). Juxtatumoral desmoplastic stromal reaction is associated with high tumor cell dissociation in squamous cell carcinomas of the uterine cervix. Ann Diagn Pathol, 10, 253-6. https://doi.org/10.1016/j.anndiagpath.2005.09.003
  6. Fregnani JH, Soares FA, Novik PR, et al (2007). Intensity of cervical inflammatory reaction as a risk factor for recurrence of carcinoma of the uterine cervix in stages IB and IIA. Sao Paulo Med J, 125, 231-6. https://doi.org/10.1590/S1516-31802007000400008
  7. Fridman WH, Pages F, Sautes-Fridman C, et al (2012). The immune contexture in human tumours: impact on clinical outcome. Nat Rev Cancer, 12, 298-306. https://doi.org/10.1038/nrc3245
  8. Horn LC, Fischer U, Raptis G, et al (2006a). Pattern of invasion is of prognostic value in surgically treated cervical cancer patients. Gynecol Oncol, 103, 906-11. https://doi.org/10.1016/j.ygyno.2006.05.046
  9. Horn LC, Hommel N, Roschlau U, et al (2012). Peritumoral stromal remodeling, pattern of invasion and expression of c-met/HGF in advanced squamous cell carcinoma of the cervix uteri, FIGO stages III and IV. Eur J Obstet Gynecol Reprod Biol, 163, 76-80. https://doi.org/10.1016/j.ejogrb.2012.03.019
  10. Jass JR, O'Brien MJ, Riddell RH, et al (2007). Recommendations for the reporting of surgically resected specimens of colorectal carcinoma. Hum Pathol, 38, 537-45. https://doi.org/10.1016/j.humpath.2006.11.009
  11. Kainz C, Gitsch G, Tempfer C, et al (1994). Vascular space invasion and inflammatory stromal reaction as prognostic factors in patients with surgically treated cervical cancer stage IB to IIB. Anticancer Res, 14, 2245-8.
  12. Kristensen GB, Abeler VM, Risberg B, et al (1999). Tumor size, depth of invasion, and grading of the invasive tumor front are the main prognostic factors in early squamous cell cervical carcinoma. Gynecol Oncol, 74, 245-51. https://doi.org/10.1006/gyno.1999.5420
  13. Polanska UM, Orimo A (2013). Carcinoma-associated fibroblasts: Non-neoplastic tumour-promoting mesenchymal cells. J Cell Physiol, 228, 1651-7. https://doi.org/10.1002/jcp.24347
  14. Suprasert P, Srisomboon J, Charoenkwan K, et al (2010). Twelve years experience with radical hysterectomy and pelvic lymphadenectomy in early stage cervical cancer. J Obstet Gynaecol, 30, 294-8. https://doi.org/10.3109/01443610903585192
  15. Tsujino T, Seshimo I, Yamamoto H, et al (2007). Stromal myofibroblasts predict disease recurrence for colorectal cancer. Clin Cancer Res, 13, 2082-90. https://doi.org/10.1158/1078-0432.CCR-06-2191

Cited by

  1. Prognostic Model in Patients with Early-stage Squamous Cell Carcinoma of the Uterine Cervix: A Combination of Invasive Margin Pathological Characteristics and Lymphovascular Space Invasion vol.14, pp.11, 2013, https://doi.org/10.7314/APJCP.2013.14.11.6935
  2. Prognostic Evaluation of Tumor-Stroma Ratio in Patients with Early Stage Cervical Adenocarcinoma Treated by Surgery vol.16, pp.10, 2015, https://doi.org/10.7314/APJCP.2015.16.10.4363
  3. The Level of Squamous Cell Carcinoma Antigen and Lymph Node Metastasis in Locally Advanced Cervical Cancer vol.16, pp.11, 2015, https://doi.org/10.7314/APJCP.2015.16.11.4719
  4. p53, Cyclin D1, p21 (WAF1) and Ki-67 (MIB1) Expression at Invasive Tumour Fronts of Oral Squamous Cell Carcinomas and Development of Local Recurrence vol.17, pp.3, 2016, https://doi.org/10.7314/APJCP.2016.17.3.1243