TY - JOUR
T1 - Post-recurrence survival in patients with cervical cancer
AU - Cibula, David
AU - Dostálek, Lukáš
AU - Jarkovsky, Jiri
AU - Mom, Constantijne H
AU - Lopez, Aldo
AU - Falconer, Henrik
AU - Scambia, Giovanni
AU - Ayhan, Ali
AU - Kim, Sarah H
AU - Isla Ortiz, David
AU - Klat, Jaroslav
AU - Obermair, Andreas
AU - Di Martino, Giampaolo
AU - Pareja, Rene
AU - Manchanda, Ranjit
AU - Kosťun, Jan
AU - Dos Reis, Ricardo
AU - Meydanli, Mehmet Mutlu
AU - Odetto, Diego
AU - Laky, Rene
AU - Zapardiel, Ignacio
AU - Weinberger, Vit
AU - Benešová, Klára
AU - Borčinová, Martina
AU - Cardenas, Fernando
AU - Wallin, Emelie
AU - Pedone Anchora, Luigi
AU - Akilli, Huseyin
AU - Abu-Rustum, Nadeem R
AU - Barquet-Muñoz, Salim Abraham
AU - Javůrková, Veronika
AU - Fischerová, Daniela
AU - van Lonkhuijzen, Luc R C W
N1 - Funding Information: This work was supported by grants from Charles University in Prague (UNCE 204065 and PROGRES Q28/LF1), Ministry of Health , Czech Republic (MH CZ – DRO-VFN64165), and the National Institutes of Health / National Cancer Institute Cancer Center ( P30 CA008748 ). Publisher Copyright: © 2021
PY - 2021/12/23
Y1 - 2021/12/23
N2 - BACKGROUND: Up to 26% of patients with early-stage cervical cancer experience relapse after primary surgery. However, little is known about which factors influence prognosis following disease recurrence. Therefore, our aims were to determine post-recurrence disease-specific survival (PR-DSS) and to identify respective prognostic factors for PR-DSS.METHODS: Data from 528 patients with early-stage cervical cancer who relapsed after primary surgery performed between 2007 and 2016 were obtained from the SCANN study (Surveillance in Cervical CANcer). Factors related to the primary disease and recurrence were combined in a multivariable Cox proportional hazards model to predict PR-DSS.RESULTS: The 5-year PR-DSS was 39.1% (95% confidence interval [CI] 22.7%-44.5%), median disease-free interval between primary surgery and recurrence (DFI1) was 1.5 years, and median survival after recurrence was 2.5 years. Six significant variables were identified in the multivariable analysis and were used to construct the prognostic model. Two were related to primary treatment (largest tumour size and lymphovascular space invasion) and four to recurrence (DFI1, age at recurrence, presence of symptoms, and recurrence type). The C-statistic after 10-fold cross-validation of prognostic model reached 0.701 (95% CI 0.675-0.727). Three risk-groups with significantly differing prognoses were identified, with 5-year PR-DSS rates of 81.8%, 44.6%, and 12.7%.CONCLUSIONS: We developed the robust model of PR-DSS to stratify patients with relapsed cervical cancer according to risk profiles using six routinely recorded prognostic markers. The model can be utilised in clinical practice to aid decision-making on the strategy of recurrence management, and to better inform the patients.
AB - BACKGROUND: Up to 26% of patients with early-stage cervical cancer experience relapse after primary surgery. However, little is known about which factors influence prognosis following disease recurrence. Therefore, our aims were to determine post-recurrence disease-specific survival (PR-DSS) and to identify respective prognostic factors for PR-DSS.METHODS: Data from 528 patients with early-stage cervical cancer who relapsed after primary surgery performed between 2007 and 2016 were obtained from the SCANN study (Surveillance in Cervical CANcer). Factors related to the primary disease and recurrence were combined in a multivariable Cox proportional hazards model to predict PR-DSS.RESULTS: The 5-year PR-DSS was 39.1% (95% confidence interval [CI] 22.7%-44.5%), median disease-free interval between primary surgery and recurrence (DFI1) was 1.5 years, and median survival after recurrence was 2.5 years. Six significant variables were identified in the multivariable analysis and were used to construct the prognostic model. Two were related to primary treatment (largest tumour size and lymphovascular space invasion) and four to recurrence (DFI1, age at recurrence, presence of symptoms, and recurrence type). The C-statistic after 10-fold cross-validation of prognostic model reached 0.701 (95% CI 0.675-0.727). Three risk-groups with significantly differing prognoses were identified, with 5-year PR-DSS rates of 81.8%, 44.6%, and 12.7%.CONCLUSIONS: We developed the robust model of PR-DSS to stratify patients with relapsed cervical cancer according to risk profiles using six routinely recorded prognostic markers. The model can be utilised in clinical practice to aid decision-making on the strategy of recurrence management, and to better inform the patients.
KW - Early-stage cervical cancer
KW - Multivariable model
KW - Post-recurrence disease-specific survival
KW - Prognosis
KW - Recurrence
KW - Risk profile
UR - http://www.scopus.com/inward/record.url?scp=85121818981&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ygyno.2021.12.018
DO - https://doi.org/10.1016/j.ygyno.2021.12.018
M3 - Article
C2 - 34955236
SN - 0090-8258
JO - Gynecologic Oncology
JF - Gynecologic Oncology
ER -