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From the Division of Gynecologic Oncology and Department of Pathology, UCLA School of Medicine, and the Jonsson Comprehensive Cancer Center, Los Angeles, California.
One hundred and two patients were treated for primary adenocarcinoma of the uterine cervix over a ten-year period from 1973 to 1982. Of these, 51 patients underwent initial surgical management that included a pelvic and para-aortic lymphadenectomy with a radical hysterectomy or a surgical staging operation. Clinical lesion size, grade, and depth of stromal invasion were correlated with lymph node metastasis and survival. The incidence of positive lymph nodes was 14.6% for stage I and 40.0% for stage II. Positive lymph nodes were documented in none of 15 patients with lesions smaller than 2 cm, 16.7% (five of 30) with 2 to 4 cm, and 82.3% (five of six) with larger than 4 cm; 5.3% of grade 1 tumors, 11.1% of grade 2, and 50.0% of grade 3. There were no lymph node metastases (zero of six) in patients with a tumor that had a depth invasion of less than 2 mm, whereas positive nodes were found in 11.1%) (two of 18) patients with 2 to 5 mm of invasion, 28.6% (two of seven) with 5 to 10 mm, and 57.1% (four of seven) with greater than 10 mm of invasion. Five-year survival was 82.9% for stage I and 42.9% for stage II patients; 91.7% with negative lymph nodes, and 10% with positive nodes (P < .0001). The size of the primary tumor (P < .0001), tumor grade (P < .05), and depth of invasion (P < .05) correlated with patient survival. Large tumors (greater than 4 cm) of cervical adenocarcinoma and those of high tumor grade correlate with a high likelihood of pelvic and paraaortic lymph node metastasis. Conversely, no patient with small lesions (less than 2 cm) had lymph node metastasis, whereas one of these patients with a grade 3 lesion invasive to a depth of 5 mm recurred in the lung. Lesions of intermediate dimension (2 to 4 cm) were associated with lymph node metastases when high tumor grade or invasion greater than 5 mm was present. All but one patient with lymph node metastases died with distant metastases
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