Patterns of metastases in cervical cancer: a population-based study

Abstract

To investigate the incidence, prognosis, and treatment modality of different metastatic sites in cervical cancer.

Methods: We used the surveillance epidemiology and end results (SEER) database to collect cervical cancer patients with metastasis from 2010-2016. Kaplan-Meier survival analyses and log-rank tests were used to compare overall survival between groups. Univariate and multivariate Cox proportional hazards regression analyses were used for identifying the prognostic factors in metastatic cervical cancer.

Results: In total, 1347 patients with distant metastatic cervical cancer were selected for the study. The average age of patients with metastatic cervical cancer was 57 years old. Unmarried white patients were the majority. About 7.9%, 53.3%, and 64.6% patients were treated with surgery, radiation, and chemotherapy, respectively. Additionally, lungs were the most common metastatic sites. The survivals of single-site metastases were similar, which were better than multi-organ metastases. Lung metastatic patients were older than other metastatic patients, and with poorer differentiation and higher stage tumors. In terms of treatment, bone metastatic patients were more commonly treated with radiotherapy (68.4%) than other metastatic patterns. Surgery, radiation, and chemotherapy all prolonged survival months of single-site and multi-site metastatic patients. Furthermore, age, ethnicity, tumor stage, surgery, radiotherapy, chemotherapy, and metastatic sites were independent prognostic factors for patients with metastatic cervical cancer.

Conclusions: This large-population based study showed that the most common metastatic site of cervical cancer is lung. Although lung metastatic patients harbor older ages and poorer differentiation and higher stage tumors than other sites, the prognosis of lung metastasis is similar to other single metastatic sites. However, the single-site metastatic patients survive longer than multi-site metastatic patients. Surgery, radiotherapy, and chemotherapy all bring benefit to patients with metastases, which may guide the treatment in metastatic cervical cancers.

Keywords: Cervical cancer; SEER; metastasis; overall survival; prognosis.

Figure 1

Flowchart of patient selection.

Figure 2

Kaplan-Meier curves of the overall survival in cervical cancer. A. Stratified by different metastatic location (bone vs. brain: P=0.107; bone vs. liver: P=0.108; bone vs. lung: P=0.983; bone vs. >1 site: P<0.001; brain vs. liver: P=0.349; brain vs. lung: P=0.068; brain vs. >1 site: P=0.636; liver vs. lung: P=0.080; liver vs. >1 site: P=0.002; lung vs. >1 site: P<0.001). B. Stratified by different metastases number (P<0.001).

Figure 3

Kaplan-Meier curves of the overall survival in cervical cancer when stratified by treatment and metastases number. A. Surgery in single metastatic patients; B. Surgery in multi-site metastatic patients; C. Radiation in single metastatic patients; D. Radiation in multi-site metastatic patients; E. Chemotherapy in single metastatic patients; F. Chemotherapy on multi-site metasta patients.