Clinical implication of surgically treated early-stage cervical cancer with multiple high-risk factors

• Published in: Journal of gynecologic oncology Vol. 26; no. 1; pp. 3 - 11
• Main Authors: Matsuo, Koji, Mabuchi, Seiji, Okazawa, Mika, Kawano, Mahiru, Kuroda, Hiromasa, Kamiura, Shoji, Kimura, Tadashi
• Format: Journal Article
• Language: English
• Published: Korea (South) Asian Society of Gynecologic Oncology; Korean Society of Gynecologic Oncology 01.01.2015; 대한부인종양학회
• Subjects: Adult; Chemoradiotherapy, Adjuvant; Female; Humans; Hysterectomy - methods; Lymphatic Metastasis; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Original; Radiotherapy, Adjuvant; Retrospective Studies; Risk Factors; Survival Analysis; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; 산부인과학; Uterine Cervical Neoplasms; Combined Modality Therapy; Retrospective Studies; Risk Factors; Neoplasm Recurrence, Local; Survival Analysis
• ISSN: 2005-0380; 2005-0399
• DOI: 10.3802/jgo.2015.26.1.3

Presence of high-risk factor in cervical cancer is known to be associated with decreased survival outcomes. However, the significance of multiple high-risk factors in early-stage cervical cancer related to survival outcomes, recurrence patterns, and treatment implications is not well elucidated. A retrospective study was conducted for surgically treated cervical cancer patients (stage IA2-IIB, n=540). Surgical-pathological risk factors were examined and tumors expressing ≥1 high-risk factors (nodal metastasis, parametrial involvement, or positive surgical margin) were eligible for analysis (n=177, 32.8%). Survival analysis was performed based on the number of high-risk factors and the type of adjuvant therapy. There were 68 cases (38.4%) expressed multiple high-risk factors (2 high-risk factors: n=58, 32.8%; 3 high-risk factors: n=10, 5.6%). Multiple high-risk factors remained an independent prognosticator for decreased survival outcomes after controlling for age, histology, stage, and treatment type (disease-free survival: hazard ratio [HR], 2.34; p=0.002; overall survival: HR, 2.32; p=0.007). Postoperatively, 101 cases (57.1%) received concurrent chemoradiotherapy (CCRT) and 76 cases (42.9%) received radiotherapy (RT) alone. CCRT was beneficial in single high-risk factor cases: HRs for CCRT over RT alone for cumulative risk of locoregional and distant recurrence, 0.27 (p=0.022) and 0.27 (p=0.005), respectively. However, tumor expressing multiple high-risk factors completely offset the benefit of CCRT over RT alone for the risk of distant recurrence: HR for locoregional and distant recurrence, 0.31 (p=0.071) and 0.99 (p=0.980), respectively. Special consideration for the significance of multiple high-risk factors merits further investigation in the management of surgically treated early-stage cervical cancer.