Patterns of failure and prognostic factor analyses in locally advanced cervical cancer patients staged by magnetic resonance imaging and treated with curative intent.

Earlier we had shown that tumor volume and corpus invasion were important prognostic factors in cervical cancer and that corpus invasion was associated with nodal metastases. In view of these findings, we wanted to examine the factors associated with the patterns of relapse in cervical cancer patients who were staged by magnetic resonance imaging (MRI) and treated with curative intent. This was a retrospective study of locoregionally advanced cervical cancer patients treated with curative intent. All patients had examination under anesthesia and pretreatment MRI. Potential prognostics examined were FIGO stage, clinical diameter, histology, corpus invasion, tumor volume, and age. Outcome measures examined were times to failure, local failure, nodal failure, and distant failure. There were 249 eligible patients. The median age of the patients was 58 years, 85% had squamous histology, and 63% of tumors exhibited corpus invasion. Median tumor volume was 33.5 mL (range 1-628). The mean follow-up was 4.5 years. Eighty-five patients had relapsed and 89 died (70 following failure and 19 otherwise). At 5 years, for all patients, the failure-free rate was 62%, the local failure-free rate 88%, the nodal failure-free rate 69%, and the distant failure-free rate 74%. Corpus invasion, tumor volume, and age were all highly significantly and independently related to risk of failure at local, nodal, and distant (except tumor volume) sites. In the presence of these factors, clinical tumor diameter and FIGO stage were not significantly related to risk of any type of failure.