Prognostic value of risk factors in cervical squamous cell carcinoma based on tumour infiltration depth

To evaluate whether the prognostic significance of distinct risk factors differs according to tumour infiltration depth in cervical squamous cell carcinoma.

We performed a retrospective cohort study of 621 patients treated at our institution between June 2012 and March 2019. Postoperative histopathological evaluation classified patients into two groups: Group 1 (n = 321) demonstrated complete full-thickness infiltration (100%) of the cervical stromal wall, whereas Group 2 (n = 320) exhibited partial stromal infiltration (≤ 80%).

Multivariate Cox regression survival analysis revealed that tumour volume(gTV) > 30.8 cm³, lymph node metastasis(gLNM), and vaginal invasion(gVI) were independent prognostic factors for 5-year survival in Group 1 (all p < 0.05), associated with 163%, 206%, and 80% increased 5-year mortality risk, respectively. In Group 2, lymph node metastasis(gLNM) persisted as the sole independent prognostic factor for 5-year survival (p = 0.03), representing a 290% higher 5-year mortality risk.

Lymph node metastasis remains an independent prognostic factor irrespective of tumour infiltration depth. With increasing infiltration depth, the prognostic significance of tumour volume, vaginal invasion, vascular involvement and pathological grade becomes more pronounced. For patients with serosal infiltration, postoperative concurrent chemoradiotherapy should be considered for those exhibiting large tumour volume or vaginal invasion, even in the absence of other high-risk factors, to reduce local recurrence and distant metastasis while improving survival outcomes.