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J Gynecol Oncol. 2015 Jan;26(1):3-11. doi: 10.3802/jgo.2015.26.1.3. Epub 2014 Oct 13.

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

Author information

1
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, USA.; Norris Comprehensive Cancer Center, Los Angeles, CA, USA. koji.matsuo@gmail.com.
2
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
3
Department of Gynecology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.

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 ≥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.

KEYWORDS:

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

PMID:
25310856
PMCID:
PMC4302282
DOI:
10.3802/jgo.2015.26.1.3
[Indexed for MEDLINE]
Free PMC Article

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