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. 2007 Jul 5;125(4):231-6.
doi: 10.1590/s1516-31802007000400008.

Intensity of cervical inflammatory reaction as a risk factor for recurrence of carcinoma of the uterine cervix in stages IB and IIA

José Humberto Tavares Guerreiro Fregnani  1 , Fernando Augusto Soares, Pablo Roberto Novik, Ademar Lopes, Maria do Rosário Dias de Oliveira Latorre
Affiliations

Intensity of cervical inflammatory reaction as a risk factor for recurrence of carcinoma of the uterine cervix in stages IB and IIA

José Humberto Tavares Guerreiro Fregnani et al. Sao Paulo Med J. .

Abstract
in English, Portuguese

Context and objective: Inflammatory reaction intensity has been indicated as a possible recurrence risk factor in carcinoma of the uterine cervix. Some authors observed greater risk with weak inflammatory reaction, while others described the opposite. This study aimed to evaluate risk factors for initial-stage uterine cervix carcinoma recurrence (IB and IIA), considering inflammatory reaction intensity.

Design and setting: Retrospective cohort at Hospital do Câncer A. C. Camargo.

Methods: 289 patients with diagnosed uterine cervix carcinoma (stages IB and IIA) who underwent radical surgery between 1980 and 1999 were studied. Data were collected from medical records. Histological sections from tumors and lymph nodes could be reviewed in 247 cases. Five-year disease-free survival rates were calculated using the Kaplan-Meier method and curves were compared using the log-rank test. Cox's proportional-hazards model was used for multivariate analysis. Recurrence risk was estimated using hazard ratios (HR).

Results: Forty-three recurrences were found. Multivariate analysis identified the following independent recurrence risk factors: number of metastatic pelvic lymph nodes (one lymph node: HR = 3.3 [1.3-8.3]; two or three: HR = 5.3 [1.5-18.6]; four or more: HR = 7.6 [1.7-33.2]), tumor invasion depth (deepest third: HR = 2.1 [1.1-4.1]) and inflammatory reaction intensity in the uterine cervix (absent or slight: HR = 2.5 [1.1-5.7]).

Conclusion: This study identified that absent or slight inflammatory reaction was an independent risk factor for recurrence. The other risk factors were the number of metastatic pelvic lymph nodes and invasion of the deepest third of the uterine cervix.

CONTEXTO E OBJETIVO:: A intensidade da reação inflamatória é citada como possível fator de risco para recorrência do carcinoma do colo do útero (CCU). Alguns autores observaram aumento do risco com reação inflamatória fraca, enquanto outros descreveram o oposto. Este estudo procurou avaliar os fatores de risco para recorrência do CCU em estádios iniciais (IB e IIA), considerando na análise a reação inflamatória.

TIPO DE ESTUDO E LOCAL:: Coorte retrospectiva, no Centro de Tratamento e Pesquisa Hospital A. C. Camargo (Hospital do Câncer).

MÉTODOS:: Estudaram-se 289 pacientes com diagnóstico de CCU (estádios IB e IIA) submetidas à cirurgia radical entre 1980 e 1999. Realizou-se a coleta de dados nos prontuários. Os cortes histológicos dos tumores e dos linfonodos foram revistos em 247 casos. As taxas de sobrevida livre de doença em cinco anos foram calculadas pelo método de Kaplan-Meier e as curvas comparadas pelo teste de log-rank. Para a análise multivariada empregou-se o modelo de riscos proporcionais de Cox. A estimativa do risco de recorrência foi o hazard ratio (HR).

RESULTADOS:: Registraram-se 43 recorrências. A análise multivariada identificou os seguintes fatores de risco independentes para recorrência: número de linfonodos pélvicos metastáticos (1 linfonodo: HR = 3,3 [1,3-8,3]; 2 ou 3 linfonodos: HR = 5,3 [1,5-18,6]; 4 ou mais linfonodos: HR=7,6 [1,7 – 33,2]), profundidade de invasão do tumor (terço profundo: HR = 2,1 [1,1-4,1]) e intensidade da reação inflamatória no colo do útero (ausente ou leve: HR = 2,5 [1,1-5,7]).

CONCLUSÃO:: Este estudo identificou a reação inflamatória ausente ou de intensidade leve como fatores de risco independentes para recorrência. Os outros fatores de risco foram o número de linfonodos pélvicos metastáticos e a invasão do terço profundo do colo do útero.

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Conflict of interest: None

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