Prognostic Value of Pathological Characteristics of Invasive Margins in Early-stage Squamous Cell Carcinomas of theUterine Cervix

Background: To evaluate the pathological characteristics of invasive margins in early-stage cervical squamouscell carcinomas and their association with other clinicopathological features including clinical outcomes. Materialsand
Methods: Patients with FIGO stage IB-IIA cervical squamous cell carcinomas who received surgical treatmentand had available follow-up information were identified. Their histological slides were reviewed for prognosticvariables including tumor size, grade, extent of invasion, lymphovascular invasion, involvement of vaginal marginor parametrium, and lymph node metastasis. The characteristics of invasive margins including invasive pattern(closed, finger-like, or spray-like type), degree of stromal desmoplasia, and degree of peritumoral inflammatoryreaction were evaluated along the entire invasive fronts of tumours. Associations between the characteristics ofinvasive margins and other clinicopathological variables and disease-free survival were assessed.
Results: A totalof 190 patients were included in the study with a median follow-up duration of 73 months. Tumour recurrencewas observed in 18 patients (9%). Spray-like invasive pattern was significantly more associated as comparedwith closed or finger-like invasive pattern (p=0.005), whereas the degree of stromal desmoplasia or peritumoralinflammatory reaction was not. Low degree of peritumoral inflammatory reaction appeared linked with lymphnode metastasis (p=0.021). In multivariate analysis, a spray-like invasive pattern was independently associatedwith marked stromal desmoplasia (p=0.013), whilst marked desmoplasia was also independently associated withlow inflammatory reactions (p=0.009). Furthermore, low inflammatory reactions were independently associatedwith positive margins (p=0.022) and lymphovascular invasion (p=0.034). The patients with spray-like invasivepattern had a significantly lower disease-free survival compared with those with closed or finger-like pattern(p=0.004).
Conclusions: There is a complex interaction between cancer tissue at the invasive margin and changesin surrounding stroma. A spray-like invasive pattern has a prognostic value in patients with early-stage cervicalsquamous cell carcinoma.