Multivariate analysis of the morphometric characteristics of tumours as prognostic factors in the survival of patients with uterine cervix cancer treated with radical surgery Mariano Martin-Loeches a,* , Rafael M. Ortı ´ b , Eduardo Cazorla a , Enrique Asins a , Joaquin Llixiona a a Service of Gynaecological Oncology, Department of Gynaecology, ‘‘La Fe’’ University Hospital, Valencia, Spain b Service of Preventive Medicine, Clı ´nic University Hospital, Valencia, Spain Accepted 18 April 2002 Abstract Objectives: To analyse the influence of tumour size and anatomopathological characteristics in the prognosis of patients with early-stage cancer of the uterine cervix treated with radical surgery. Study design: A historical study of 114 patients treated at the Maternity Hospital ‘‘La Fe’’ in Valencia was undertaken during the period 1971–1989. The influence of the principal risk factors on prognosis were studied and their effect adjusted using a multivariate analysis based on the Cox proportional hazards model. Results: A greater dimension of the tumour, tumour area, tumour volume, tumour-cervix quotient and stromal invasion depth all have a highly significant and negative correlation with survival and disease-free survival intervals. In the multivariate analysis, tumour volume and stromal invasion depth maintained their significance as indicators of an adverse prognosis regarding the disease-free survival interval, as did the stromal invasion depth in the case of survival. Conclusions: The most important prognostic factor in the evolution of patients with a cervical carcinoma is the stromal invasion depth followed by tumour size. # 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Tumour size; Invasion depth; Cancer of the uterine cervix; Radical surgery; Prognosis 1. Introduction Primary tumour size is the most important independent prognostic factor to influence survival in patients with uterine cervix cancer [1–3], even in the absence of lymph node metastasis or vascular space invasion. Furthermore, this importance increases when associated with the grade of tumour differentiation, affected post-surgical margins and the presence of nodal invasion [3]. Several authors [1,2] affirm that the most important prognostic factor in patients with cancer of the uterine cervix is the stromal invasion depth measured in the operation sample, although Finan et al. [4,5] find no prognostic significance in either this or tumour size. Tumour size and stromal invasion depth have been pro- posed as predictive factors of recurrence in patients without lymph node metastasis or tumour-free surgical margins by other authors [3,6], as it is these factors which indicate tumour volume. Roman et al. [7], together with other authors [8,9], state that these factors constitute independent predic- tors of lymph node invasion. Burghardt and Pickel [2] demonstrate that tumour size, expressed as tumour area, is a better predictor of tumour evolution than the surgical stage and, when expressed as the tumour-cervix quotient, is related with both the degree of lymphatic metastasis and survival to 5 years. Numerous studies validate these affirmations [10]. Roman et al. [7], Brughardt and Pickel [2] and other authors [6,11] have observed an increase in local recurrence in relation to the tumour-cervix quotient. The objective of this work is to study the influence of tumour size and anatomopathology characteristics, consid- ered by many authors to be the most important independent prognostic factors, on the survival of patients with cancer of the uterine cervix treated with radical surgery. European Journal of Obstetrics & Gynecology and Reproductive Biology 105 (2002) 170–176 * Corresponding author. Present address: Calle Abu ´-Zeya ´n, 8-1 o -2 a , 03700 Denia (Alicante), Spain. Tel.: þ34-9657-8-7894; fax: þ34-9657-8-0713. E-mail address: mm-loeches@coma.es (M. Martin-Loeches). 0301-2115/02/$ – see front matter # 2002 Elsevier Science Ireland Ltd. All rights reserved. PII:S0301-2115(02)00156-2