J Gynecol Oncol.  2015 Jan;26(1):3-11. 10.3802/jgo.2015.26.1.3.

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

• Matsuo K
• Mabuchi S
• Okazawa M
• Kawano M
• Kuroda H
• Kamiura S
• Kimura T

• KMID: 2158796
• DOI: http://doi.org/10.3802/jgo.2015.26.1.3

Abstract

OBJECTIVE
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.
METHODS
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 > or =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.
RESULTS
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.
CONCLUSION
Special consideration for the significance of multiple high-risk factors merits further investigation in the management of surgically treated early-stage cervical cancer.

Keyword

Combined Modality Therapy; Neoplasm Recurrence, Local; Retrospective Studies; Risk Factors; Survival Analysis; Uterine Cervical Neoplasms

MeSH Terms

Adult
Chemoradiotherapy, Adjuvant
Female
Humans
Hysterectomy/*methods
Lymphatic Metastasis
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Radiotherapy, Adjuvant
Retrospective Studies
Risk Factors
Survival Analysis
Uterine Cervical Neoplasms/pathology/*surgery

Figure

• 

  Fig. 1 Multiple high-risk factors and survival outcomes of early-stage cervical cancer. Numbers at risk are shown per group at the bottom of each figure. (A) Disease-free survival and (B) overall survival based on the number of high-risk factors (lymph node metastasis, parametrium invasion, and resection margin involvement). Cumulative risks for (C) locoregional and (D) distant recurrence are shown based on the number of high-risk factors.

• 

  Fig. 2 Multiple high-risk factors and recurrent pattern in early-stage cervical cancer. Numbers at risk are shown per group at the bottom of each figure. Cumulative risks for (A) locoregional and (B) distant recurrence are shown based on adjuvant therapy type in single high-risk factor cases. Cumulative risks for (C) locoregional and (D) distant recurrence are shown based on adjuvant therapy type in multiple high-risk factor cases. RT, radiotherapy; CCRT, concurrent chemoradiotherapy. *Log-rank test.

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