Role of adjuvant therapy in intermediate-risk cervical cancer patients – Subanalyses of the SCCAN study

• Published in: Gynecologic oncology Vol. 170; pp. 195 - 202
• Main Authors: Cibula, David, Akilli, Huseyin, Jarkovsky, Jiri, van Lonkhuijzen, Luc, Scambia, Giovanni, Meydanli, Mehmet Mutlu, Ortiz, David Isla, Falconer, Henrik, Abu-Rustum, Nadeem R., Odetto, Diego, Klát, Jaroslav, dos Reis, Ricardo, Zapardiel, Ignacio, Di Martino, Giampaolo, Presl, Jiri, Laky, Rene, López, Aldo, Weinberger, Vit, Obermair, Andreas, Pareja, Rene, Poncová, Renata, Mom, Constantijne, Bizzarri, Nicolò, Borčinová, Martina, Aslan, Koray, Salcedo Hernandez, Rosa Angélica, Fons, Guus, Benešová, Klára, Dostálek, Lukáš, Ayhan, Ali
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2023
• Subjects: Adjuvant treatment; Cervical cancer; Combined Modality Therapy; Female; GOG criteria; Humans; Hysterectomy; Intermediate risk; Medicin och hälsovetenskap; Neoplasm Staging; Prognosis; Radial surgery; Radiotherapy; Radiotherapy, Adjuvant; Retrospective Studies; Uterine Cervical Neoplasms - pathology; Radial surgery; Radiotherapy; Cervical cancer; GOG criteria; Adjuvant treatment; Intermediate risk
• ISSN: 0090-8258; 1095-6859; 1095-6859
• DOI: 10.1016/j.ygyno.2023.01.014

The “intermediate-risk” (IR) group of early-stage cervical cancer patients is characterized by negative pelvic lymph nodes and a combination of tumor-related prognostic risk factors such as tumor size ≥2 cm, lymphovascular space invasion (LVSI), and deep stromal invasion. However, the role of adjuvant treatment in these patients remains controversial. We investigated whether adjuvant (chemo)radiation is associated with a survival benefit after radical surgery in patients with IR cervical cancer. We analyzed data from patients with IR cervical cancer (tumor size 2–4 cm plus LVSI OR tumor size >4 cm; N0; no parametrial invasion; clear surgical margins) who underwent primary curative-intent surgery between 2007 and 2016 and were retrospectively registered in the international multicenter Surveillance in Cervical CANcer (SCCAN) study. Of 692 analyzed patients, 274 (39.6%) received no adjuvant treatment (AT−) and 418 (60.4%) received radiotherapy or chemoradiotherapy (AT+). The 5-year disease-free survival (83.2% and 80.3%; PDFS = 0.365) and overall survival (88.7% and 89.0%; POS = 0.281) were not significantly different between the AT− and AT+ groups, respectively. Adjuvant (chemo)radiotherapy was not associated with a survival benefit after adjusting for confounding factors by case-control propensity score matching or in subgroup analyses of patients with tumor size ≥4 cm and <4 cm. In univariable analysis, adjuvant (chemo)radiotherapy was not identified as a prognostic factor in any of the subgroups (full cohort: PDFS = 0.365; POS = 0.282). Among patients with IR early-stage cervical cancer, radical surgery alone achieved equal disease-free and overall survival rates to those achieved by combining radical surgery with adjuvant (chemo)radiotherapy. •We investigated the survival benefit of adjuvant therapy (AT) after radical surgery in intermediate-risk (IR) cervical cancer.•Of 692 IR cervical cancer patients in the SCANN study, 60.4% received AT (AT+) and 39.6% did not (AT−).•5-year DFS (83.2% vs. 80.3%) and OS (88.7% vs. 89.0%) rates were similar in the AT− and AT+ groups.•AT did not confer a significant survival benefit even after applying propensity score matching for confounding factors.