David Cibula1, Lukáš Dostálek2, Jiri Jarkovsky3, Constantijne H Mom4, Aldo Lopez5, Henrik Falconer6, Anna Fagotti7, Ali Ayhan8, Sarah H Kim9, David Isla Ortiz10, Jaroslav Klat11, Andreas Obermair12, Fabio Landoni13, Juliana Rodriguez14, Ranjit Manchanda15, Jan Kosťun16, Ricardo Dos Reis17, Mehmet M Meydanli18, Diego Odetto19, Rene Laky20, Ignacio Zapardiel21, Vit Weinberger22, Klára Benešová3, Martina Borčinová2, Darwin Pari5, Sahar Salehi6, Nicolò Bizzarri7, Huseyin Akilli8, Nadeem R Abu-Rustum9, Rosa A Salcedo-Hernández10, Veronika Javůrková11, Jiří Sláma2, Luc R C W van Lonkhuijzen4. 1. Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital (Central and Eastern European Gynecologic Oncology Group, CEEGOG), Prague, Czech Republic. Electronic address: dc@davidcibula.cz. 2. Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital (Central and Eastern European Gynecologic Oncology Group, CEEGOG), Prague, Czech Republic. 3. Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic. 4. Amsterdam Medical Center, Amsterdam, the Netherlands. 5. Department of Gynecological Surgery, National Institute of Neoplastic Diseases, Lima, Peru. 6. Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. 7. Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy. 8. Baskent University School of Medicine, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Ankara, Turkey. 9. Memorial Sloan Kettering Cancer Center, USA. 10. Gynecology Oncology Center, National Institute of Cancerology Mexico, Mexico. 11. Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital and University of Ostrava, Ostrava, Czech Republic. 12. Queensland Centre for Gynaecological Cancer, The University of Queensland, Australia. 13. University of Milano-Bicocca, Department of Obstetrics and Gynecology, Gynaecologic Oncology Surgical Unit, ASST-Monza, San Gerardo Hospital, Monza, Italy. 14. Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia. 15. Wolfson Institute of Preventive Medicine, Barts Cancer Centre, Queen Mary University of London, & Barts Health NHS Trust, London, UK. 16. Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, Prague, Czech Republic. 17. Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. 18. Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health and Research Hospital, University of Health Sciences, Ankara, Turkey. 19. Department of Gynecologic Oncology, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina. 20. Gynecology, Medical University of Graz, Graz, Austria. 21. Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain. 22. University Hospital Brno, Medical Faculty of Masaryk University, Czech Republic.
Abstract
PURPOSE: Current guidelines for surveillance strategy in cervical cancer are rigid, recommending the same strategy for all survivors. The aim of this study was to develop a robust model allowing for individualised surveillance based on a patient's risk profile. METHODS: Data of 4343 early-stage patients with cervical cancer treated between 2007 and 2016 were obtained from the international SCCAN (Surveillance in Cervical Cancer) consortium. The Cox proportional hazards model predicting disease-free survival (DFS) was developed and internally validated. The risk score, derived from regression coefficients of the model, stratified the cohort into significantly distinctive risk groups. On its basis, the annual recurrence risk model (ARRM) was calculated. RESULTS: Five variables were included in the prognostic model: maximal pathologic tumour diameter; tumour histotype; grade; number of positive pelvic lymph nodes; and lymphovascular space invasion. Five risk groups significantly differing in prognosis were identified with a five-year DFS of 97.5%, 94.7%, 85.2% and 63.3% in increasing risk groups, whereas a two-year DFS in the highest risk group equalled 15.4%. Based on the ARRM, the annual recurrence risk in the lowest risk group was below 1% since the beginning of follow-up and declined below 1% at years three, four and >5 in the medium-risk groups. In the whole cohort, 26% of recurrences appeared at the first year of the follow-up, 48% by year two and 78% by year five. CONCLUSION: The ARRM represents a potent tool for tailoring the surveillance strategy in early-stage patients with cervical cancer based on the patient's risk status and respective annual recurrence risk. It can easily be used in routine clinical settings internationally.
PURPOSE: Current guidelines for surveillance strategy in cervical cancer are rigid, recommending the same strategy for all survivors. The aim of this study was to develop a robust model allowing for individualised surveillance based on a patient's risk profile. METHODS: Data of 4343 early-stage patients with cervical cancer treated between 2007 and 2016 were obtained from the international SCCAN (Surveillance in Cervical Cancer) consortium. The Cox proportional hazards model predicting disease-free survival (DFS) was developed and internally validated. The risk score, derived from regression coefficients of the model, stratified the cohort into significantly distinctive risk groups. On its basis, the annual recurrence risk model (ARRM) was calculated. RESULTS: Five variables were included in the prognostic model: maximal pathologic tumour diameter; tumour histotype; grade; number of positive pelvic lymph nodes; and lymphovascular space invasion. Five risk groups significantly differing in prognosis were identified with a five-year DFS of 97.5%, 94.7%, 85.2% and 63.3% in increasing risk groups, whereas a two-year DFS in the highest risk group equalled 15.4%. Based on the ARRM, the annual recurrence risk in the lowest risk group was below 1% since the beginning of follow-up and declined below 1% at years three, four and >5 in the medium-risk groups. In the whole cohort, 26% of recurrences appeared at the first year of the follow-up, 48% by year two and 78% by year five. CONCLUSION: The ARRM represents a potent tool for tailoring the surveillance strategy in early-stage patients with cervical cancer based on the patient's risk status and respective annual recurrence risk. It can easily be used in routine clinical settings internationally.
Authors: P Zola; L Fuso; S Mazzola; E Piovano; S Perotto; A Gadducci; L Galletto; F Landoni; T Maggino; F Raspagliesi; E Sartori; G Scambia Journal: Gynecol Oncol Date: 2007-09-14 Impact factor: 5.482
Authors: S Polterauer; C Grimm; G Hofstetter; N Concin; C Natter; A Sturdza; R Pötter; C Marth; A Reinthaller; G Heinze Journal: Br J Cancer Date: 2012-08-07 Impact factor: 7.640
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
Authors: Nabil Manzour; Luis Chiva; Enrique Chacón; Nerea Martin-Calvo; Felix Boria; José A Minguez; Juan L Alcazar Journal: Ann Surg Oncol Date: 2022-04-16 Impact factor: 4.339