OBJECTIVE: Our aim was to investigate the clinical features and outcomes following recurrence after primary radical hysterectomy for cervical cancer. METHODS: Clinical data of 121 documented recurrent cervical cancer patients who received primary radical hysterectomy and bilateral pelvic lymphadenectomy between 1993 and 2000 at Chang Gung Memorial Hospital were retrospectively reviewed. Clinicopathological variables, primary treatment, failure pattern, salvage treatment and outcomes were analyzed. Outcomes of the current study were compared to those treated between 1982 and 1992 (1982-1992 cohort). RESULTS: Cancer recurrence was documented at a median time to recurrence (TTR) of 28.4 months (1.2-129.9 months). Assessable failure patterns (n=106) included loco-regional in 46.3%, distant in 47.2% and combined pelvic-distant in 6.6%. 5-year survival of the 121 patients was 22.3% after cancer recurrence. The median survival after recurrence (SAR) was 16.4 months (range 0-144.2 months). By multivariate analysis, extravaginal sites of recurrence (HR 2.56, 1.28-5.12; p=0.008) and HPV16-positive (HR 0.60, 0.38-0.96; p=0.033) were significant prognostic factors for SAR. Non-squamous histology or pelvic node metastasis at primary surgery were not significant (5-year SAR of 16.4% and 20.0%, respectively), though they were (0% and 0%) in the 1993-2000 cohort. Salvage surgery and concurrent chemoradiation were more frequently used in the 1993-2000 cohort (48.3% versus 12.4%). CONCLUSION: HPV16-negativity and extravaginal relapse were significant poor prognostic factors. Future randomized controlled trials for recurrent cervical cancer could be stratified for these two factors if further studies using external validation confirm these results.
OBJECTIVE: Our aim was to investigate the clinical features and outcomes following recurrence after primary radical hysterectomy for cervical cancer. METHODS: Clinical data of 121 documented recurrent cervical cancerpatients who received primary radical hysterectomy and bilateral pelvic lymphadenectomy between 1993 and 2000 at Chang Gung Memorial Hospital were retrospectively reviewed. Clinicopathological variables, primary treatment, failure pattern, salvage treatment and outcomes were analyzed. Outcomes of the current study were compared to those treated between 1982 and 1992 (1982-1992 cohort). RESULTS:Cancer recurrence was documented at a median time to recurrence (TTR) of 28.4 months (1.2-129.9 months). Assessable failure patterns (n=106) included loco-regional in 46.3%, distant in 47.2% and combined pelvic-distant in 6.6%. 5-year survival of the 121 patients was 22.3% after cancer recurrence. The median survival after recurrence (SAR) was 16.4 months (range 0-144.2 months). By multivariate analysis, extravaginal sites of recurrence (HR 2.56, 1.28-5.12; p=0.008) and HPV16-positive (HR 0.60, 0.38-0.96; p=0.033) were significant prognostic factors for SAR. Non-squamous histology or pelvic node metastasis at primary surgery were not significant (5-year SAR of 16.4% and 20.0%, respectively), though they were (0% and 0%) in the 1993-2000 cohort. Salvage surgery and concurrent chemoradiation were more frequently used in the 1993-2000 cohort (48.3% versus 12.4%). CONCLUSION:HPV16-negativity and extravaginal relapse were significant poor prognostic factors. Future randomized controlled trials for recurrent cervical cancer could be stratified for these two factors if further studies using external validation confirm these results.
Authors: David Cibula; Lukáš Dostálek; Jiri Jarkovsky; Constantijne H Mom; Aldo Lopez; Henrik Falconer; Giovanni Scambia; Ali Ayhan; Sarah H Kim; David Isla Ortiz; Jaroslav Klat; Andreas Obermair; Giampaolo Di Martino; Rene Pareja; Ranjit Manchanda; Jan Kosťun; Ricardo Dos Reis; Mehmet Mutlu Meydanli; Diego Odetto; Rene Laky; Ignacio Zapardiel; Vit Weinberger; Klára Benešová; Martina Borčinová; Fernando Cardenas; Emelie Wallin; Luigi Pedone Anchora; Huseyin Akilli; Nadeem R Abu-Rustum; Salim Abraham Barquet-Muñoz; Veronika Javůrková; Daniela Fischerová; Luc R C W van Lonkhuijzen Journal: Gynecol Oncol Date: 2021-12-23 Impact factor: 5.304