Lymph node metastases, cell type, age, HPV status and type, neoadjuvant chemotherapy and treatment failures in...

Conflicting evidence on the prognostic influence of some of the clinical and histopathological variables in cervical cancer of the HPV status and type and chemotherapeutic response prompted a number of reviews from nearly 40 years experience in a tertiary referral centre. The collation and analyses of these data with those from recent literature allow some proposals to be made. The disease is more prevalent in the young women in whom, in many centers, the mortality is also higher; the latter may be related to the reported increase in both small cell types and adeno and adenosquamous carcinoma--a finding more marked in the young. Lymph node metastases, related to increasing grade, size, stage and lymph space invasion, are unequivocally associated with a worse prognosis. Resolution of the exact nature of the intimate association of this disease with the human papilloma virus remains to be resolved as does the influence on prognosis of the tumor HPV status and that of the different oncogenic types. Reports on the efficiency of neoadjuvant platinum based combination chemotherapy are generally promising but vary considerably depending on the regimen used. Its value will not be determined without properly conducted large randomized studies.