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. 2022 Apr 11:12:782030.
doi: 10.3389/fonc.2022.782030. eCollection 2022.

Prognostic Effect of Primary Recurrence Patterns in Squamous Cervical Carcinoma After Radical Surgery

Zongkai Zhang  1 , Long Jiang  2 , Rui Bi  1   3 , Xiaohua Wu  1   4 , Guihao Ke  1   4 , Jun Zhu  1   4
Affiliations

Prognostic Effect of Primary Recurrence Patterns in Squamous Cervical Carcinoma After Radical Surgery

Zongkai Zhang et al. Front Oncol. .

Abstract

Objective: To examine the effect of primary recurrence patterns on the prognosis of squamous cervical cancer after initial treatment.

Methods: Primary recurrence patterns and prognostic factors were examined in stage IB-IIA cervical cancer patients after initial treatment. Recurrence site (locoregional recurrence and distant metastasis or in-field and out-field recurrence for patients receiving adjuvant radiotherapy) and subtype (nodal and organ recurrence) were examined. Clinicopathological characteristics and survival rates were evaluated to generate a prognostic nomogram.

Results: A total of 472 patients were included. The median follow-up period, 5-year overall (OS) rate, and median OS were 59.1 months, 33.7%, and 24.0 months, respectively. Overall, 38.8% and 61.2% of the patients had locoregional recurrence and distant metastasis, respectively, and survival rates were comparable in these groups. Patients with nodal recurrence had better OS than those with organ recurrence (38.3% vs 30.7%, respectively; P = 0.001). Patients not receiving adjuvant radiotherapy had increased risk of pelvic recurrence [odds ratio (OR) = 0.148; 95% confidence interval[(CI): 0.075-0.291, P = 0.000]. Positive lymph-vascular space invasion (OR= 1.928; 95% CI: 1.151-3.229, P = 0.013) and no chemotherapy (OR = 0.521; 95% CI: 0.317-0.733, P = 0.040) increased the risk of distant metastasis. Positive lymph node status after initial treatment were associated with nodal recurrence (OR = 3.729; 95% CI: 1.838-7.563, P = 0.000), while elevated preoperative squamous cell carcinoma antigen (SCC-Ag) levels were associated with organ recurrence (OR = 1.642; 95% CI: 1.325-2.265, P = 0.002). Recurrence subtype, therapy for relapse, the International Federation of Gynecology and Obstetrics stage, adjuvant radiotherapy, preoperative SCC-Ag levels, and risk subgroup were independently associated with OS.

Conclusions: Primary recurrence patterns were associated with specific clinicopathological characteristics of cervical cancer. Recurrent cervical cancer prognosis was mainly affected by recurrence location and subtype.

Keywords: cervical cancer; distant metastasis; locoregional recurrence; recurrence patterns; therapy for relapse.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Five-year overall survival (OS) rates for different recurrence sites. (B) OS rates for patients with locoregional recurrence (LR) with or without adjuvant radiotherapy (ART) and the OS for patients with the out-field recurrence. (C) Five-year OS rates for patients with different recurrence subtypes, (D) patients with lymph node recurrence, (E) patients with or without isolated lung metastasis, and (F) patients with or without vaginal stump.
Figure 2
Figure 2
(A) Nomogram predicting 5-year OS rates for patients with relapse after initial treatment. The nomogram was based on scores corresponding to each independent variable. The total score (bottom of the scale) indicates the probabilities of 5-year OS rates. (B) The predicted and observed 5-year OS rates were used for model calibration. The x-axis displays nomogram-predicted probability, while the y-axis displays observed survival rates estimated using the Kaplan-Meier method. The dotted line indicates excellent model calibration, with good concordance between the predicted and observed survival rates. The vertical bars represent 95% confidence intervals. (C) Receiver operating characteristic curves with area under the curve values compare nomogram and traditional model discrimination. The blue lines represent survival rates predicted by the nomogram.
See this image and copyright information in PMC

References

    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin (2018) 68(6):394–424. doi: 10.3322/caac.21492 - DOI - PubMed
    1. Lees BF, Erickson BK, Huh WK. Cervical Cancer Screening: Evidence Behind the Guidelines. Am J Obstet Gynecol (2016) 214(4):438–43. doi: 10.1016/j.ajog.2015.10.147 - DOI - PubMed
    1. Lei T, Mao WM, Lei TH, Dai LQ, Fang L, Chen WQ, et al. Incidence and Mortality Trend of Cervical Cancer in 11 Cancer Registries of China. Chin J Cancer Res (2011) 23(1):10–4. doi: 10.1007/s11670-011-0010-x - DOI - PMC - PubMed
    1. American College of O, Gynecologists . ACOG Practice Bulletin. Diagnosis and Treatment of Cervical Carcinomas. Number 35, May 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet (2002) 78(1):79–91. doi: 10.1016/s0020-7292(02)90092-5 - DOI - PubMed
    1. Gaffney DK, Erickson-Wittmann BA, Jhingran A, Mayr NA, Puthawala AA, Moore D, et al. ACR Appropriateness Criteria(R) on Advanced Cervical Cancer Expert Panel on Radiation Oncology-Gynecology. Int J Radiat Oncol Biol Phys (2011) 81(3):609–14. doi: 10.1016/j.ijrobp.2010.11.005 - DOI - PubMed