J Gynecol Oncol.  2017 Jul;28(4):e42. 10.3802/jgo.2017.28.e42.

Impact of time interval between radical hysterectomy with pelvic node dissection and initial adjuvant therapy on oncological outcomes of early stage cervical cancer

• Hanprasertpong J
• Jiamset I
• Geater A
• Leetanaporn K
• Peerawong

• KMID: 2413429
• DOI: http://doi.org/10.3802/jgo.2017.28.e42

Abstract

OBJECTIVE
To determine the impact of time interval (TI) from radical hysterectomy with pelvic node dissection (RHND) to adjuvant therapy on oncological outcomes in cervical cancer.
METHODS
The study included 110 stage IA2-IB1 cervical cancer patients who underwent RHND and adjuvant therapy. The patients were divided into 2 groups based on the cut-off points of TI of 4 and 6 weeks, respectively. The associations of TI and clinicopathologic factors with oncological outcomes were evaluated using Cox proportional-hazards regression.
RESULTS
The median TI was 4.5 weeks. There were no statistical differences in 5-year recurrence-free survival (RFS) (89.2% vs. 81.0%, and 83.2% vs. 100.0%) or 5-year overall survival (OS) rates (90.9% vs. 97.2%, and 93.2% vs. 100.0%) between patients according to TI (≤4 vs. >4, and ≤6 vs. >6 weeks, respectively). Deep stromal invasion (p=0.037), and parametrial involvement (PI) (p=0.002) were identified as independent prognostic factors for RFS, together with the interaction between TI and squamous cell carcinoma histology (p<0.001). In patients with squamous cell carcinoma, a TI longer than 4 weeks was significantly associated with a worse RFS (hazard ratio [HR]=15.8; 95% confidence interval [CI]=1.4-173.9; p=0.024). Univariate analysis showed that only tumor size (p=0.023), and PI (p=0.003) were significantly associated with OS.
CONCLUSION
Delay in administering adjuvant therapy more than 4 weeks after RHND in early stage squamous cell cervical cancer results in poorer RFS.

Keyword

Uterine Cervical Neoplasms; Hysterectomy; Time Factor; Adjuvant Radiotherapy; Adjuvant Chemoradiotherapy; Prognosis

MeSH Terms

Adenocarcinoma/secondary/*therapy
Adult
Aged
Carcinoma, Adenosquamous/secondary/*therapy
Carcinoma, Squamous Cell/secondary/*therapy
Chemoradiotherapy, Adjuvant
Disease-Free Survival
Female
Humans
*Hysterectomy
*Lymph Node Excision
Middle Aged
Neoplasm Invasiveness
Neoplasm Staging
Radiotherapy, Adjuvant
Retrospective Studies
Survival Rate
Time Factors
Treatment Outcome
Tumor Burden
Uterine Cervical Neoplasms/pathology/*therapy
Young Adult