Faculty of Medicine

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Author: search.filters.author.Zografski, GeorgeSubject: search.filters.subject.disease-free survival

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    Prognostic significance of the HPV status in early stage cervical carcinoma
    (Macedonian Academy of Sciences and Arts, 2006-09)
    Kubelka-Sabit, Katerina
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    Prodanova, Irina
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    Yashar, Genghis
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    Zografski, George
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    Aims: In order to evaluate their prognostic significance, the parameters of the human papilloma virus (HPV) status were correlated to the lympho-nodal and tumor status, maximal diameter, minimal thickness of uninvolved stroma, histologic type, grade of differentiation, lympho-vascular space invasion, degree of lymphocytic inflammatory stromal reaction at the invasion front, age and the disease-free survival (DFS) of the patients with early stage invasive cervical carcinomas. Material and methods: 77 cases of cervical carcinomas, limited to the uterus, surgically treated and postoperatively irradiated, were selected for this retrospective study. HPV DNA status (presence and HPV type, type of hybridization signal and number of positive cells per sample) was evaluated using sensitive in situ hybridization detection kit with catalyzed signal amplification with biotinylated probes for types 6/11, 16/18 and 31/33 or 31/33/51. Results: The presence of HPV DNA was detected in 45 (58.4%) cases. Thirty-two (71.1%) showed positivity for HPV type 16/18, 8 (17.8%) for 31/33, whereas multiple infection was detected in (8.9%) 4 cases. Dot hybridization signal was found in 31 (68.9%), diffuse in 2 (4.4%) and mixed in 12 (26.7%) cases. More than five positive nuclei per sample were found in 37 (82.2%) of the cases. Only the presence of HPV was associated with absence of regional lymph node involvement, presence of moderate/abundant lymphocytic infiltration and longer 5 and 10-year DFS. Conclusions: According to our results, more extensive studies are needed to assess the real prognostic influence of the other parameters of HPV status in early stage cervical carcinomas.
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    Blood vessel invasion and inflammatory stromal reaction at the invasion front as additional significant prognostic factors in surgically treated patients with cervical carcinoma.
    (Springer, 2001-09)
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    Yashar, Genghis
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    Veljanoska, Slavica
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    Kubelka, Katerina
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    Prodanova, Irina
    Introduction: The objective of this study was to evaluate the prognostic significance of 23 clinical and histopathological variables in relation to disease-free (DFS) and overall survival (OS) in patients with early stage cervical carcinomas. Methods: A retrospective analysis of 237 patients with cervical carcinoma, undergoing radical hysterectomy and postoperative irradiation between 1988 and 1997 was conducted. The operative specimens were subjected to detailed and uniform histopathological work-up. The patients were staged according to the postoperative TNM classification of UICC (1997) guidelines. Mean follow-up time was 57 (18-124) months. Results: The 5 and 10-year OS rate was 80.8%, while DFS rates at 5 and 10 years were 76.8% and 75.5%, respectively. In multivariate analysis, blood vessel invasion, pelvic lymph node metastases, tumor diameter, inflammatory stromal reaction at the invasion front, and minimum thickness of uninvolved cervical stroma/parametrial extension, were independent and significant variables. The prognostic index, as an indicator of the patient's place in the prognostic spectrum, defined by the Cox regression model, was able to categorize the patients into three distinct risk groups. The 5-year DFS and OS rates of the low-, intermediate-, and high-risk groups were 97.5%, 86.3%, and 43.8%, vs. 98.8%, 84.5%, and 45.3%, respectively (P<0.0001). Conclusions: The prognostic index could be a sound basis for an appropriate planning of the following therapeutical strategy for the surgically treated patients with cervical carcinoma. The postoperative TNM classification should be modified, incorporating the blood vessel invasion and the inflammatory stromal reaction at the invasion front, as additional significant prognostic factors.
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    The implementation of prognostic index and risk grouping in surgically treated cervical carcinoma patients: A prospective validation study.
    (Springer, 2008-05)
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    Prodanova, Irina
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    Kubelka-Sabit, Katerina
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    Veljanovska, Slavica
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    Arsovski, Oliver
    BACKGROUND: The objective of this prospective study was to validate the prognostic criteria defined by the results of our previous study in an independent population of surgically treated cervical carcinoma patients. METHOD: The study group consisted of 340 patients who underwent abdominal hysterectomy with pelvic lymphadenectomy as primary therapy between 2000 and 2005. Based on the scores of the variables (blood vessel invasion, lymph node metastases, tumor diameter, degree of inflammatory reaction at the invasive front, and minimum thickness of uninvolved cervical stroma/parametrial extension) and calculated prognostic index (PI) values, the patients were divided into three prognostic groups. RESULTS: During the follow-up period (range, 1.6–89.7, mean, 39.7±22.2 months) recurrences were observed in 1% (1/97), 12.2% (16/131) and 23.2% (26/112) of the low-, intermediate-, or high-risk group patients, respectively. The 5-year disease-free survival (DFS) rates of the low, intermediate, and high-risk groups were 98.82%, 84.57%, and 74.01%, respectively. The differences in DFS rates were statistically significant (P<0.0001). In order to validate the model from our previous study, we have compared DFS rates between the groups. There was no difference in DFS rate between low-risk groups, in spite of the fact that majority of the patients in this study were not irradiated, while radiotherapy was administrated invariably to all the patients included in the original study. Similarly, DFS did not differ significantly between the intermediate-risk groups from both studies, which could be expected since radiotherapy was administrated to majority of the patients (125/131) in this study. In contrast, the high-risk group patients in this study had significantly higher DFS rate (74.01% vs. 44.24, P=0.0010), probably as the result of the adjuvant chemotherapy administrated to 69% of them. CONCLUSION: PI could be a sound and reliable basis for an appropriate planning of the following therapeutical strategy of the surgically treated cervical cancer patients.