Neoadjuvant Radio-Chemotherapy for Uterine Cervix Carcinoma: A Regression Grading System as a New Prognostic Parameter
Gian Franco Zannoni, Valerio Gaetano Vellone, Chiara Brunelli, Giulia Amodio, Guido Fadda, Esther Diana Rossi, Giovanni Scambia, Valeria Masciullo. Catholic University, Rome, Italy
Background: Concomitant radio chemotherapy represents an effective option for cervical cancer. Surgical treatment following radio-chemotherapy is still controversial. Therefore we analyzed the effectiveness of this procedure on a series of surgical specimens collected in our institution. Pathological findings and a tumor regression grading system (pR) are presented.
Design: Archival slides from the Surgical Pathology Unit of Agostino Gemelli Hospital – Catholic University were revised for the period 1996-2012 in search of Uterine Cervical Carcinoma cases after neoajuvant therapy. We identified 249 consecutive, unselected patients, which underwent radical hysterectomy with lymph nodes removal and peritoneal sampling. All the surgical specimens were routinely processed. In all the cases the whole cervix was sectioned clockwise and examined on multiple histological slides. The following tumor regression grading is proposed
- pR0: Complete Pathological Response: no invasive residual neoplastic cells are observed
- pR1: Partial Pathological Response: clusters of invasive neoplastic cells <0,3 cm of diameter
- pR2: No Pathological Response: neoplastic masses >0,3 cm.
All the cases were restaged according to pTNM and FIGO staging system.
Results: All the specimens showed variable but relevant signs of regression: 101 patients resulted pR0 (40,6%); 73 patients resulted pR1 (29,3%); 75 patients resulted pR2 (30,1%). In pR0 cases the previous tumour volume was replaced by fibrotic tissue; foamy macrophages and erosive cervicitis were more often seen (p<0,001). In pR1 cases neoplastic residual is significantly associated with regressive and reactive phenomena such as multinucleated cell and calcium deposits (p=0,009). pR2 residuals significantly infiltrate more than pR1, involving a larger percentage of the cervical wall (p<0,001), more frequently shows signs of neoplastic embolism (p=0,009), have metastatic lymph nodes (p<0,001) and positive surgical margins; all these features resulted in a higher FIGO staging. For all these reasons pR2 patient had an adverse prognosis with a worse Overall and Disease-Free Survival (p<0,001).
Conclusions: Histopathological examination of cervical carcinoma following neoadjuvant treatment represents a challenging issue: when present the residual can be scarce and deeply alterated. The proposed regression grading system could have a relevant role in characterizing prognosis of these patients and planning further treatments.
Category: Gynecologic & Obstetrics
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 189, Wednesday Afternoon