The Survival After Surgery of Clinically Early-stage Cervical Cancer in Chonburi Hospital and Multivariable Analysis of Prognostic Factors Influencing Survival
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Abstract
Objective: To evaluate 5-year overall survival (OS), 5-year disease-free survival (DFS), recurrent rate and identified prognostic clinicopathological factors of patients with clinically early-stage cervical cancer treated with primary surgery in Chonburi Hospital.
Materials and Methods: The medical records of early-stage cervical cancer patients undergoing surgery treatment from January 2012 to September 2023 were reviewed. OS and DFS were obtained. Patients' age, stage, tumor size, histologic type, depth, degree of stromal invasion, lympho-vascular space invasion (LVSI), surgical margin, pelvic node status, and adjuvant treatment were assessed for correlation with DFS.
Results: Three hundred and twelve patients were included. The mean age was 46.8 ±11.6 years, and the median follow-up was 67.0 months. Fifty-three patients (17.2%) developed recurrent disease. The 5-year OS was 100%, 93.9%, 88.5%, and 81.8% (p = 0.001) according to the FIGO 2018 stage IA, IB1, IB2, and IB3, respectively. The 5-year DFS was 100%, 95.1%, 87.5%, and 74.5%, correspondingly (p = 0.001). The discordance between clinical and surgical upstaging was 13.8% according to FIGO 2018 criteria. In multivariate analysis, stage beyond IB3, tumor size over 4 cm, LVSI, and deep stromal invasion were significant prognostic variables. In contrast, adjuvant postoperative radiotherapy (PORT) in the intermediate and high-risk groups was the protective factor for DFS with a hazard ratio of 0.39 [0.20 – 0.76, p = 0.006].
Conclusion: The 5-year OS and DFS of clinically early-stage cervical cancer were 85.3% and 84.0%, respectively. PORT was the protective factor for recurrence.
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References
Wilailak S. Epidemiologic report of gynecologic cancer in Thailand. Journal of Gynecologic Oncology. 2009;20(2).
Bray F CM, Mery L, Piñeros M, Znaor A, Zanetti R, Ferlay J. Cancer Incidence in Five Continents Volume XI. IARC Scientific Publication No 166.
Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. Cancer of the cervix uteri: 2021 update. International Journal of Gynecology & Obstetrics. 2021;155(S1):28-44.
Gray H. Primary Management of Early Stage Cervical Cancer (IA1-IB) and Appropriate Selection of Adjuvant Therapy. Journal of the National Comprehensive Cancer Network. (2008;6(1):47–52.).
Bhatla N, Singhal S, Dhamija E, Mathur S, Natarajan J, Maheshwari A. Implications of the revised cervical cancer FIGO staging system. Indian J Med Res. 2021;154(2):273-83.
Yanaranop M, Tuipae S, Nakrangsee S. Comparison of Survival Outcomes in Early Stage Invasive Adenocarcinoma with Squamous Cell Carcinoma of the Uterine Cervix. J Med Assoc Thai. 2017;100 Suppl 1:S77-86.
Chittithaworn S, Hanprasertpong J, Tungsinmunkong K, Geater A. Association between prognostic factors and disease-free survival of cervical cancer stage IB1 patients undergoing radical hysterectomy. Asian Pacific journal of cancer prevention : APJCP. 2007;8(4):530-4.
Bangsomboon P, Kittisiam T, Chaowawanit W. Survival Rate of Cervical Cancer Patients According to the 2018 FIGO Staging System: A tertiary hospital based study, Vajira Hospital, Bangkok. Thai Journal of Obstetrics and Gynaecology. 2022;30(1):60-7.
Chandeying N, Hanprasertpong J. The prognostic impact of histological type on clinical outcomes of early-stage cervical cancer patients whom have been treated with radical surgery. J Obstet Gynaecol. 2017;37(3):347-54.
Suprasert P, Srisomboon J, Charoenkwan K, Siriaree S, Cheewakriangkrai C, Kietpeerakool C, et al. Twelve years experience with radical hysterectomy and pelvic lymphadenectomy in early stage cervical cancer. Journal of Obstetrics and Gynaecology. 2010;30(3):294-8.
Techapalokun A, Khongthip Y. Risk Factors Associated with Parametrial Involvement in Early-stage Cervical Cancer. Thai Journal of Obstetrics and Gynaecology. 2022;30(3):207-13.
Luengyosluechakul S, Temtanakitpaisan A, Kietpeerakool C, Chumworathayi B, Kleebkaow P, Aue-aungkul A, et al. Parametrial Invasion in Early-Stage Cervical Cancer. Thai Journal of Obstetrics and Gynaecology. 2020;28(3):160-6.
III WAP, Liu PY, II RJB, Stock RJ, Monk BJ, Berek JS, et al. Concurrent Chemotherapy and Pelvic Radiation Therapy Compared With Pelvic Radiation Therapy Alone as Adjuvant Therapy After Radical Surgery in High-Risk Early-Stage Cancer of the Cervix. Journal of Clinical Oncology. 2000;18(8):1606-13.
Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol. 1999;73(2):177-83.
Irie T, Kigawa J, Minagawa Y, Itamochi H, Sato S, Akeshima R, et al. Prognosis and clinicopathological characteristics of Ib-IIb adenocarcinoma of the uterine cervix in patients who have had radical hysterectomy. Eur J Surg Oncol. 2000;26(5):464-7.
Salib MY, Russell JHB, Stewart VR, Sudderuddin SA, Barwick TD, Rockall AG, et al. 2018 FIGO Staging Classification for Cervical Cancer: Added Benefits of Imaging. Radiographics. 2020;40(6):1807-22.
Vetter MH, Smrz S, Gehrig PA, Peng K, Matsuo K, Davidson BA, et al. Pathologic and clinical tumor size discordance in early-stage cervical cancer: Does it matter? Gynecologic Oncology. 2020;159(2):354-8.
Levinson K, Beavis AL, Purdy C, Rositch AF, Viswanathan A, Wolfson AH, et al. Beyond Sedlis-A novel histology-specific nomogram for predicting cervical cancer recurrence risk: An NRG/GOG ancillary analysis. Gynecol Oncol. 2021;162(3):532-8.
Alonso-Espías M, Gorostidi M, Gracia M, García-Pineda V, Diestro MD, Siegrist J, et al. Role of Adjuvant Radiotherapy in Patients with Cervical Cancer Undergoing Radical Hysterectomy. J Pers Med. 2023;13(10).
Lee SI, Atri M. 2018 FIGO Staging System for Uterine Cervical Cancer: Enter Cross-sectional Imaging. Radiology. 2019;292(1):15-24.
Mahajan A. Improving access to global cancer services. The Lancet. 2023;401(10385):1338-9.
Manchana T, Sirisabya N, Lertkhachonsuk R, Worasethsin P, Khemapech N, Sittisomwong T, et al. Long term complications after radical hysterectomy with pelvic lymphadenectomy. J Med Assoc Thai. 2009;92(4):451-6.