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CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2019; 79(02): 198-204
DOI: 10.1055/a-0828-7681
GebFra Science
Original Article
Georg Thieme Verlag KG Stuttgart · New York

The Prognostic Impact of Grading in FIGO IB and IIB Squamous Cell Cervical Carcinomas

Prognostischer Effekt von Grading bei FIGO-IB- und -IIB- Plattenepithelkarzinom der Cervix uteri
Christine E. Brambs
1   Department of Obstetrics and Gynecology, Technical University Munich, Munich, Germany
,
Anne Katrin Höhn
2   Institute of Pathology, Division of Gynecologic Pathology, University Leipzig, Germany
,
Bettina Hentschel
3   Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Germany
,
Uta Fischer
2   Institute of Pathology, Division of Gynecologic Pathology, University Leipzig, Germany
4   Department of Obstetrics and Gynecology, University Leipzig, Germany
,
Karl Bilek
4   Department of Obstetrics and Gynecology, University Leipzig, Germany
,
Lars-Christian Horn
2   Institute of Pathology, Division of Gynecologic Pathology, University Leipzig, Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 15. August 2018
revised 28. Dezember 2018

accepted 29. Dezember 2018

Publikationsdatum:
18. Februar 2019 (online)

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Abstract

Background Tumor grade is one of the more controversial factors, and the data regarding its prognostic impact in squamous cell carcinoma (SCC) of the uterine cervix are controversial.

Methods The histological slides of 467 surgically treated FIGO stage IB1 to IIB cervical SCC were re-examined regarding the prognostic impact of the histological tumor grade based on the degree of keratinization (conventional tumor grade) according to the WHO recommendation on recurrence-free and overall survival as well as on the prediction of pelvic lymph node involvement.

Results 46.0% presented with well-differentiated tumors (G1, n = 215), 30.6% with moderate (G2, n = 143) and 23.3% with poor differentiation (G3, n = 109). The recurrence-free survival was significantly reduced in patients with poorly differentiated tumors (G1: 81.4%, G2: 70.6%, G3: 64.2%; p = 0.008). There was no impact on overall survival. Because of the lack of survival differences between G1- and G2-tumors, they were merged into low-grade tumors, and their prognostic outcome was compared to the high-grade group (G3-tumors). Based on this binary conventional grading system there was a significantly longer recurrence-free (low-grade: 77.1% vs. high-grade: 64.2%; p = 0.008) and overall survival (low-grade: 76.0% vs. high-grade: 65.1%; p = 0.031) in the low-grade group. However, both the conventional three-tiered and the binary grading systems (separating tumors into a low- and high-grade group) failed to predict pelvic lymph node involvement (p = 0.9 and 0.76, respectively).

Conclusion A binary grading model for the conventional tumor grade (based on the degree of keratinization) in SCC of the uterine cervix may be suitable for the prognostic survival evaluation but failed to predict pelvic lymph node involvement.

Zusammenfassung

Hintergrund Tumorgrade gehören zu den umstrittenen Faktoren bei der Einschätzung von Tumoren, und die Daten zum prognostischen Effekt von Tumorgrading für das Plattenepithelkarzinom der Cervix uteri sind kontrovers.

Methoden Die histologischen Präparate von 467 operativ behandelten FIGO-IB1- bis -IIB-Plattenepithelkarzinome der Cervix uteri wurden einer erneuten Untersuchung unterzogen. Untersucht wurde u. a. der prognostische Effekt des histologischen Tumorgrads, basierend auf das Ausmaß der Keratinisierung (konventionelles Tumorgrading) gemäß der WHO-Empfehlung zum rezidivfreien Überleben und Gesamtüberleben sowie die prognostische Aussagekraft von Grading im Hinblick auf den Lymphknotenbefall in der Beckenregion.

Ergebnisse In 46,0% der Präparate war der Tumor gut differenziert (G1, n = 215), in 30,6% war er mäßiggradig differenziert (G2, n = 143), und in 23,3% der Fälle war der Tumor schlecht differenziert (G3, n = 109). Bei Patientinnen mit schlecht differenzierten Tumoren war das rezidivfreie Überleben deutlich reduziert (G1: 81,4%, G2: 70,6%, G3: 64,2%; p = 0,008). Es gab aber keine Auswirkungen auf das Gesamtüberleben. Weil es fast keinen Unterschied in den Überlebensraten zwischen G1- und G2-Tumoren gab, wurden diese als Low-Grade-Karzinome zusammengefasst, und das prognostische Ergebnis für diese Low-Grade-Tumoren wurde mit dem der High-Grade-Gruppe (G3-Tumoren) verglichen. Bei diesem binären konventionellen Gradingsystem war das rezidivfreie Überleben (Low-grade: 77,1% vs. High-grade: 64,2%; p = 0,008) und das Gesamtüberleben (Low-grade: 76,0% vs. High-grade: 65,1%; p = 0,031) der Low-Grade-Gruppe deutlich länger. Aber sowohl das konventionelle 3-stufige System als auch das binäre Gradingsystem (bei dem die Tumoren in Low-grade und High-grade unterteilt wurden) waren nicht in der Lage, prognostische Aussagen zum Befall von Beckenlymphknoten zu machen (p = 0,9 resp. 0,76).

Schlussfolgerung Beim Plattenepithelkarzinom der Cervix uteri eignet sich ein binäres Gradingsystem für konventionelle Tumorgrade (basierend auf das Ausmaß der Keratinisierung) zwar für die prognostische Einschätzung des Überlebens, es ist aber nicht in der Lage, prognostische Aussagen zum Befall der Beckenlymphknoten zu machen.

Key words

cervix - cancer - prognosis - grading - histopathology - treatment - squamous cell - survival

Schlüsselwörter

Zervix - Krebs - Prognose - Grading - Histopathologie - Therapie - Plattenepithelzelle - Überleben
 

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