Journal of Gynecologic Oncology

Korean Society of Gynecologic Oncology (대한부인종양학회)
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Clinical implication of surgically treated early-stage cervical cancer with multiple high-risk factors

  • Matsuo, Koji (Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California) ;
  • Mabuchi, Seiji (Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine) ;
  • Okazawa, Mika (Department of Gynecology, Osaka Medical Center for Cancer and Cardiovascular Diseases) ;
  • Kawano, Mahiru (Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine) ;
  • Kuroda, Hiromasa (Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine) ;
  • Kamiura, Shoji (Department of Gynecology, Osaka Medical Center for Cancer and Cardiovascular Diseases) ;
  • Kimura, Tadashi (Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine)
  • Received : 2014.07.31
  • Accepted : 2014.09.17
  • Published : 2015.01.31
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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 ${\geq}1$ 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

References

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