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. 2022 Aug;29(8):4819-4829.
doi: 10.1245/s10434-022-11671-5. Epub 2022 Apr 16.

SUCCOR Risk: Design and Validation of a Recurrence Prediction Index for Early-Stage Cervical Cancer

Nabil Manzour  1 , Luis Chiva  2 , Enrique Chacón  1 , Nerea Martin-Calvo  3 , Felix Boria  4 , José A Minguez  1 , Juan L Alcazar  1 ; SUCCOR Study Group
Collaborators, Affiliations

SUCCOR Risk: Design and Validation of a Recurrence Prediction Index for Early-Stage Cervical Cancer

Nabil Manzour et al. Ann Surg Oncol. 2022 Aug.

Abstract

Objective: Based on the SUCCOR study database, our primary objective was to identify the independent clinical pathological variables associated with the risk of relapse in patients with stage IB1 cervical cancer who underwent a radical hysterectomy. Our secondary goal was to design and validate a risk predictive index (RPI) for classifying patients depending on the risk of recurrence.

Methods: Overall, 1116 women were included from January 2013 to December 2014. We randomly divided our sample into two cohorts: discovery and validation cohorts. The test group was used to identify the independent variables associated with relapse, and with these variables, we designed our RPI. The index was applied to calculate a relapse risk score for each participant in the validation group.

Results: A previous cone biopsy was the most significant independent variable that lowered the rate of relapse (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.17-0.60). Additionally, patients with a tumor diameter >2 cm on preoperative imaging assessment (OR 2.15, 95% CI 1.33-3.5) and operated by the minimally invasive approach (OR 1.61, 95% CI 1.00-2.57) were more likely to have a recurrence. Based on these findings, patients in the validation cohort were classified according to the RPI of low, medium, or high risk of relapse, with rates of 3.4%, 9.8%, and 21.3% observed in each group, respectively. With a median follow-up of 58 months, the 5-year disease-free survival rates were 97.2% for the low-risk group, 88.0% for the medium-risk group, and 80.5% for the high-risk group (p < 0.001).

Conclusion: Previous conization to radical hysterectomy was the most powerful protective variable of relapse. Our risk predictor index was validated to identify patients at risk of recurrence.

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Conflict of interest statement

Nabil Manzour, Enrique Chacón, Nerea Martin-Calvo, Felix Boria, José A. Minguez, Juan L. Alcazar, and Luis Chiva have declared no conflicts of interest.

Figures

Fig. 1
Fig. 1
Study population. FIGO International Federation of Gynecology and Obstetrics, MRI magnetic resonance imaging, PET positron emission tomography, CT computed tomography, ECOG Eastern Cooperative Oncology Group, MIS minimally invasive surgery, ESGO European Society of Gynaecological Oncology, LN lymph node, ADC adenocarcinoma
Fig. 2
Fig. 2
ROC curve with an AUC and 95% CIs for the a testing cohort and b validation cohort for the risk of relapse. ROC receiver operating characteristic, AUC area under the curve, CIs confidence intervals
Fig. 3
Fig. 3
Predicted risk of relapse by score and risk group
Fig. 4
Fig. 4
Hazard ratios for the a risk of relapse and b overall survival, by risk groups in the validation cohort (low, medium, and high risk). OS overall survival
See this image and copyright information in PMC

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