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Journal of Cancer Research and Clinical Oncology

, Volume 145, Issue 2, pp 457–462 | Cite as

Prognostic relevance of low-grade versus high-grade FIGO IB1 squamous cell uterine cervical carcinomas

  • Lars-Christian HornEmail author
  • Anne Katrin Höhn
  • Bettina Hentschel
  • Uta Fischer
  • Karl Bilek
  • Christine E. Brambs
Original Article – Clinical Oncology
  • 69 Downloads

Abstract

Purpose

Tumor grade is one of the more controversial factors with limited prognostic information in squamous cell carcinomas (SCC) of the uterine cervix.

Methods

Histologic slides of 233 surgically treated cervical SCC (FIGO IB1) were re-examined regarding the prognostic impact of the WHO-based grading system, using the different degree of keratinization, categorizing the tumors in G1, G2 and G3 (conventional tumor grade).

Results

45.1% presented with well-differentiated tumors (G1), 29.2% with moderate (G2) and 25.8% with poor differentiation (G3). Tumor grade significantly correlated with decreased recurrence-free and overall survival. However, detailed analyses between G1- and G2-tumors failed to show any correlation with either recurrence-free or overall survival. G1- and G2-tumors were therefore merged into low-grade tumors and were compared to the high-grade group (G3-tumors). This binary conventional grading system showed an improved 5-years recurrence-free (low-grade: 90.2% vs. high-grade: 71.6%; p = 0.001) and overall survival rates (low-grade: 89.9% vs. high-grade: 71.1%; p = 0.001) for low-grade tumors. On multivariate analysis adjusted for lymph node metastasis, high-grade tumors represented a hazard ratio of 2.4 (95% CI 1.3–4.7) for reduced recurrence-free and 2.4 (95% CI 1.2–4.6) for overall survival. High-grade tumors showed a significantly higher risk for pelvic lymph node involvement [OR 2.7 (95% CI 1.4–5.5); p = 0.003]. The traditional three-tiered grading system failed to predict pelvic lymph node metastases.

Conclusion

A binary grading model for the conventional tumor grade (based on the degree of keratinization) in SCC of the uterine cervix may allow a better prognostic discrimination than the traditionally used three-tiered system.

Keywords

Cervix Cancer Prognosis Grading Histopathology Treatment Squamous cell Survival 

Notes

Funding

The authors declare that there was no funding of the study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Gynecologic, Breast and Perinatal Pathology, Institute of PathologyUniversity Hospital LeipzigLeipzigGermany
  2. 2.Institute for Medical Informatics, Statistics and EpidemiologyUniversity LeipzigLeipzigGermany
  3. 3.Division of Gynecologic Oncologic Surgery, Department of Obstetrics and Gynecology (Institute of Trier)University Hospital LeipzigLeipzigGermany
  4. 4.Department of Obstetrics and GynecologyTechnical University MunichMunichGermany

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