J Gynecol Oncol.  2020 Jan;31(1):e8. 10.3802/jgo.2020.31.e8.

Surgery of primary sites for stage IVB cervical cancer patients receiving chemoradiotherapy: a population-based study

• Li H
• Pang Y
• Cheng X

• KMID: 2500407
• DOI: http://doi.org/10.3802/jgo.2020.31.e8

Abstract

Objective
The purpose of this study was to analyze the impact of surgery of primary sites on stage IVB cervical cancer patients from a population-based database, the Surveillance, Epidemiology and End Results (SEER).
Methods
Propensity score matching was performed to minimize heterogeneity in patient between with-surgery group and without-surgery group. Clinicopathological characteristics were compared using the χ2 or Fisher's exact test. Survival analysis included the Kaplan-Meier method, log-rank test, and Cox proportional hazards model.
Results
Between 2010-2015, a total of 1,139 International Federation of Gynecology and Obstetrics (FIGO) stage IVB cervical cancer patients receiving chemoradiotherapy (CRT) were included in this retrospective study. Within post-matching cohort, the median duration of overall survival (OS) in stage IVB cervical cancer patients receiving CRT was 22 months. The overall 5-year survival rate was 25.7%. The increasing American Joint Committee on Cancer T stage (T1 vs. T2, p=0.033, hazard ratio [HR]=1.79, 95% confidence interval [CI]=1.05–3.05; T1 vs. T3, p=0.003, HR=2.20, 95% CI=1.31–3.67; T1 vs. T4, p=0.037, HR=2.75, 95% CI=1.06–7.12) and visceral metastasis (with vs. without, p=0.038, HR=1.60, 95% CI=1.03–2.49) was reported as independent risk factors of OS. Surgery of primary sites combined with CRT tended to prolong the survival of stage IVB cervical cancer patients (p<0.001, HR=0.36, 95% CI=0.21–0.61) compared with CRT, especially for patients without visceral metastasis (p=0.005, HR=0.31, 95% CI=0.14–0.70).
Conclusions
In conclusion, patients with stage IVB cervical cancer may achieve their best outcomes through CRT combined with surgery of primary sites. However, it deserves large scale prospective clinical trials to confirm.

Keyword

Cervical Cancer; Metastatic; Chemoradiotherapy; Surgery