Obstet Gynecol Sci.  2021 Mar;64(2):226-233. 10.5468/ogs.20243.

The baseline recurrence risk of patients with intermediate-risk cervical cancer

Affiliations
  • 1Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
  • 2Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan

Abstract


Objective
This study aimed to investigate the prognosis of patients with intermediate-risk cervical cancer and to evaluate the necessity of adjuvant therapy.
Methods
We conducted a retrospective chart review of patients with stage IB–II cervical cancer who underwent type III radical hysterectomy with pelvic lymphadenectomy between 2008 and 2017. In our institution, radical hysterectomy is performed as an open surgery and not as a minimally invasive surgery, and adjuvant therapy is not administered to patients with intermediate-risk cervical cancer. The intermediate-risk group included patients with 2 or more of the following factors: tumor size >4 cm, stromal invasion >1/2, and lymphovascular stromal invasion. Intermediaterisk patients with squamous cell carcinoma were included in the I-SCC group, whereas those with endocervical adenocarcinoma, usual type, or adenosquamous carcinoma were included in the I-Adeno group.
Results
There were 34 and 18 patients in the I-SCC and I-Adeno groups, respectively. The 5-year recurrence-free survival (RFS) and overall survival rates in the I-SCC group were 90.5% (95% confidence interval [CI], 85.3–95.7%) and 100% (95% CI, 100%), respectively, whereas those in the I-Adeno group were 54.9% (95% CI, 42.0–67.9%) and 76.1% (95% CI, 63.7–88.4%), respectively. Multivariate analysis revealed that endocervical adenocarcinoma, usual type, or adenosquamous carcinoma, and tumor size >4 cm had worse RFS.
Conclusion
The I-SCC group had good prognosis without adjuvant therapy; therefore, adjuvant therapy may be omitted in these patients. In contrast, the I-Adeno group had poor prognosis without adjuvant therapy; therefore, adjuvant therapy should be considered in their treatment.

Keyword

Uterine cervical neoplasms; Recurrence; Carcinoma; Squamous cells; Adenocarcinoma

Figure

  • Fig. 1 Number of patients included for analysis. Thirty-four patients were in the intermediate-risk group with squamous cell carcinoma (I-SCC group) and 18 in the intermediate-risk group with endocervical adenocarcinoma, usual type, or adenosquamous carcinoma (I-Adeno group). Thirty-eight patients were in the low-risk group with squamous cell carcinoma (L-SCC group) and 38 in the low-risk group with endocervical adenocarcinoma, usual type, or adenosquamous carcinoma (L-Adeno group). a)Histologic type other than squamous cell carcinoma,

  • Fig. 2 Kaplan-Meier estimates for recurrence-free survival (RFS) and overall survival (OS) of intermediate-risk group with squamous cell carcinoma (I-SCC group) and intermediate-risk group with endocervical adenocarcinoma, usual type, or adenosquamous carcinoma (I-Adeno group). Patients in the I-SCC group had significantly higher RFS and OS than those in the I-Adeno group (P <0.01, P= 0.02).

  • Fig. 3 Kaplan-Meier estimates for recurrence-free survival (RFS) and overall survival (OS) of intermediate-risk group with endocervical adenocarcinoma, usual type, or adenosquamous carcinoma (I-Adeno group) and low-risk group with endocervical adenocarcinoma, usual type, or adenosquamous carcinoma (L-Adeno group). Patients in the I-Adeno group had significantly lower RFS and OS than those in the L-Adeno group (P <0.01, P <0.01).


Reference

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