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. 2022 Feb;164(2):362-369.
doi: 10.1016/j.ygyno.2021.12.018. Epub 2021 Dec 23.

Post-recurrence survival in patients with cervical cancer

David Cibula  1 , Lukáš Dostálek  2 , Jiri Jarkovsky  3 , Constantijne H Mom  4 , Aldo Lopez  5 , Henrik Falconer  6 , Giovanni Scambia  7 , Ali Ayhan  8 , Sarah H Kim  9 , David Isla Ortiz  10 , Jaroslav Klat  11 , Andreas Obermair  12 , Giampaolo Di Martino  13 , Rene Pareja  14 , Ranjit Manchanda  15 , Jan Kosťun  16 , Ricardo Dos Reis  17 , Mehmet Mutlu Meydanli  18 , Diego Odetto  19 , Rene Laky  20 , Ignacio Zapardiel  21 , Vit Weinberger  22 , Klára Benešová  3 , Martina Borčinová  2 , Fernando Cardenas  5 , Emelie Wallin  6 , Luigi Pedone Anchora  7 , Huseyin Akilli  8 , Nadeem R Abu-Rustum  9 , Salim Abraham Barquet-Muñoz  10 , Veronika Javůrková  11 , Daniela Fischerová  2 , Luc R C W van Lonkhuijzen  4
Affiliations

Post-recurrence survival in patients with cervical cancer

David Cibula et al. Gynecol Oncol. 2022 Feb.

Abstract

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.

Keywords: Early-stage cervical cancer; Multivariable model; Post-recurrence disease-specific survival; Prognosis; Recurrence; Risk profile.

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Conflict of interest statement

Declaration of Competing Interest Outside the submitted work, Dr. Abu-Rustum reports grants from Stryker/Novadaq and GRAIL (paid to the institution). The remaining authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Post-recurrence disease-specific survival (PR-DSS) after recurrence in all relapsed patients (N = 528). Time 0 represents the date of diagnosis of recurrence. CI: confidence interval.
Figure 2
Figure 2
Disease-specific survival of recurring patients divided according to the following prognostic factors: (A) location of recurrence; (B) type of recurrence; (C) disease-free interval (DFI1) calculated as the time from primary surgery to the time when recurrence was diagnosed; (D) presence of symptoms at the time of recurrence diagnosis, where time 0 represents the time when recurrence was diagnosed; and (E) presence of symptoms at the time of recurrence, where time 0 represents the time of primary surgery.
Figure 3
Figure 3
Post-recurrence disease-specific survival in patients stratified by the risk score (N = 528). Time 0 represents the time when recurrence was diagnosed.
See this image and copyright information in PMC

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