David Cibula1, Lukáš Dostálek2, Jiri Jarkovsky3, Constantijne H Mom4, Aldo Lopez5, Henrik Falconer6, Giovanni Scambia7, Ali Ayhan8, Sarah H Kim9, David Isla Ortiz10, Jaroslav Klat11, Andreas Obermair12, Giampaolo Di Martino13, Rene Pareja14, Ranjit Manchanda15, Jan Kosťun16, Ricardo Dos Reis17, Mehmet Mutlu Meydanli18, Diego Odetto19, Rene Laky20, Ignacio Zapardiel21, Vit Weinberger22, Klára Benešová3, Martina Borčinová2, Fernando Cardenas5, Emelie Wallin6, Luigi Pedone Anchora7, Huseyin Akilli8, Nadeem R Abu-Rustum9, Salim Abraham Barquet-Muñoz10, Veronika Javůrková11, Daniela Fischerová2, 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 University Medical Centers, Center for Gynaecologic Oncology Amsterdam, 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
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.
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.
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Authors: David Cibula; Lukáš Dostálek; Jiri Jarkovsky; Constantijne H Mom; Aldo Lopez; Henrik Falconer; Anna Fagotti; Ali Ayhan; Sarah H Kim; David Isla Ortiz; Jaroslav Klat; Andreas Obermair; Fabio Landoni; Juliana Rodriguez; Ranjit Manchanda; Jan Kosťun; Ricardo Dos Reis; Mehmet M Meydanli; Diego Odetto; Rene Laky; Ignacio Zapardiel; Vit Weinberger; Klára Benešová; Martina Borčinová; Darwin Pari; Sahar Salehi; Nicolò Bizzarri; Huseyin Akilli; Nadeem R Abu-Rustum; Rosa A Salcedo-Hernández; Veronika Javůrková; Jiří Sláma; Luc R C W van Lonkhuijzen Journal: Eur J Cancer Date: 2021-10-16 Impact factor: 10.002
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