J Gynecol Oncol.  2020 Mar;31(2):e16. 10.3802/jgo.2020.31.e16.

Completion hysterectomy after chemoradiotherapy for locally advanced adeno-type cervical carcinoma: updated survival outcomes and experience in post radiation surgery

• Yang J
• Yang J
• Cao D
• Shen K
• Ma J
• Zhang F

• KMID: 2470869
• DOI: http://doi.org/10.3802/jgo.2020.31.e16

Abstract

OBJECTIVE
To compare patient survival outcomes between completion hysterectomy and conventional surveillance in locally advanced adenocarcinoma of the cervix after concurrent chemoradiotherapy (CCRT).
METHODS
Patients with adenocarcinoma of the cervix after CCRT were identified in a tertiary academic center database from 2004 to 2018. Patients received completion hysterectomy or surveillance after CCRT. We compared the progression-free survival (PFS) and overall survival (OS) between the patients with or without adjuvant hysterectomy. Surgery features, operative complications, and pathologic characteristics were documented. Patient outcomes were also analyzed according to clinicopathologic factors.
RESULTS
A total of 78 patients were assigned to completion surgery and 97 to surveillance after CCRT. The PFS was better in the surgery group compared to the CCRT only group, at 3 years the PFS rates were 68.1% and 45.2%, respectively (hazard ratio [HR]=0.46; 95% confidence interval [CI]=0.282-0.749; p=0.002). Adjuvant surgery was also associated with a higher rate of OS (HR=0.361; 95% CI=0.189-0.689; p=0.002), at 3 years, 87.9% and 67%, respectively. Tumor stage, size, lymph-vascular space invasion (LVSI), lymphadenopathy were associated with PFS but not with OS. Hysterectomy specimens revealed 64.1% (50/78) of the patients had pathologic residual tumor. Patients age less than 60, tumor size over 4 cm, stage IIB and persistent residual disease after CCRT were most likely to benefit from hysterectomy. Hysterectomy was associated with a lower rate of locoregional recurrence but did not reach statistical significance (5.13% vs. 13.5%, p=0.067).
CONCLUSION
Completion hysterectomy after CCRT was associated with better survival outcome compared with the current standard of care.

Keyword

Hysterectomy; Chemoradiotherapy; Uterine Cervical Neoplasms; Adenocarcinoma; Survival

MeSH Terms

Adenocarcinoma
Cervix Uteri
Chemoradiotherapy*
Disease-Free Survival
Female
Humans
Hysterectomy*
Lymphatic Diseases
Neoplasm, Residual
Recurrence
Standard of Care
Uterine Cervical Neoplasms

Figure

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  Fig. 1. PFS and OS between the 2 groups and subgroup analysis of patients with or without prRD. CCRT, concurrent chemoradiotherapy; CI, confidence interval; HR, hazard ratio; OS, overall survival; PFS, progression-free survival; psRD, post-radiation residual disease.

• 

  Fig. 2. HR of completion surgery vs. surveillance for PFS and OS in specified clinical features. CCRT, concurrent chemoradiotherapy; CI, confidence interval; HR, hazard ratio; LAN, lymphoadenopathy; LVSI, lymph-vascular space invasion; OS, overall survival; PFS, progression-free survival; RD, residual disease.

Reference

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