Recurrence pattern and prognostic factors for survival in cervical cancer with lymph node metastasis

Kılıç, Çiğdem; Cömert, Günsu Kimyon; Çakır, Caner; Yüksel, Dilek; Codal, Bahadır; Kılıç, Fatih; Türkmen, Osman; Karalök, Alper; Tekın, Özlem Moraloğlu; Boran, Nurettin; Turan, Taner

doi:10.1111/jog.14762

Cited by 15 publications

(16 citation statements)

References 22 publications

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“…The 5-year CIR was 27%, among which LR only, DR only, and LDR accounted for 40%, 46%, and 14% of recurrence patterns, respectively. In similar studies, the recurrence rate of LACC patients was 20%-30% (27,28). The most common recurrence pattern in these studies was DR with lymph node metastasis, which is similar to our results.…”

Section: Discussionsupporting

confidence: 91%

Analysis of Treatment Outcomes and Prognosis After Concurrent Chemoradiotherapy for Locally Advanced Cervical Cancer

Peng

Chen

et al. 2022

Front. Oncol.

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The aims of this study were to investigate the short-term and long-term efficacies and chronic radiotoxicity of concurrent chemoradiotherapy (CCRT) combined with image-guided adaptive brachytherapy (IGABT) in patients with locally advanced cervical cancer (LACC) and identify prognostic factors in this patient population. The clinical data of 204 patients with cervical cancer who completed CCRT and subsequent brachytherapy in our hospital between February 2015 and March 2017 were retrospectively analyzed. Short-term and long-term outcomes, chronic radiotoxicity, and prognostic factors were assessed. The median follow-up was 61.1 months. The short-term objective response (OR) rate was 85%. Lymph node metastasis before treatment was an independent predictor of OR (HR = 6.290, 95% CI: 2.211-17.897, p = 0.001). Fifty-two patients developed recurrence, with a median recurrence-free survival of 9.9 months (range, 2.4-52.2 months) and a post-recurrence survival of 12.1 months (range, 2.9-58.1 months). At 3 years, the cumulative incidence of overall recurrence was 26% (95% CI: 17-36). Multivariate analysis showed that Stage IIIB (HR = 2.332, 95% CI: 1.195-4.551, p = 0.013; reference, Stage IIB) and lymph node metastasis (HR = 4.462, 95% CI: 2.365-8.419, p < 0.001) were significant independent predictors of recurrence. Fifty-three patients developed chronic radiation proctitis (CRP). The incidence of severe CRP was approximately 5%, and the average rectal D2cm3 accumulation in patients with severe CRP was 73.4 Gy which is 3.9 Gy higher than that in patients without CRP (p = 0.013). At 4 years, the overall survival (OS) and disease-free survival rates were 65% and 62%, respectively, and lymph node metastasis before treatment was an independent prognostic risk factor for OS. The short-term and long-term efficacies of CCRT combined with IGABT for the treatment of LACC patients were relatively satisfactory. However, the short-term and long-term efficacies of patients with lymph node metastasis before treatment were poor. For patients with lymph node metastasis before treatment, more active individualized treatment strategies should be adopted. When designing a radiotherapy plan, it is necessary to strictly limit the rectal D2cm3 accumulation to prevent serious CRP.

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Section: Discussionsupporting

confidence: 91%

Analysis of Treatment Outcomes and Prognosis After Concurrent Chemoradiotherapy for Locally Advanced Cervical Cancer

Peng

Chen

et al. 2022

Front. Oncol.

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“…Several studies have shown that lymph node metastasis is an independent prognostic factor for overall survival time, 4 , 22 and is associated with distant metastases in early-stage cervical cancer, 23 , 24 especially the presence of paraaortic lymph node metastasis was significantly associated with distant recurrence. 25 There have been many similar studies, and this has been the main reason why FIGO incorporates lymph node metastatic conditions into the staging system it published in 2018. Grigsby et al analyzed a database cohort of 1282 patients newly diagnosed with cervical carcinoma from 1997 to 2019, and found that FIGO 2018 improves survival discriminatory ability for stages I and IV patients.…”

Section: Discussionmentioning

confidence: 99%

Nomogram Predicting Overall Survival in Patients with FIGO II to III Squamous Cell Cervical Carcinoma Under Radical Radiotherapy: A Retrospective Analysis Based on 2018 FIGO Staging

Zang¹,

Chen²,

Zhang³

et al. 2021

CMAR

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Purpose To present a nomogram to predict overall survival in patients with FIGO-2018 II to III squamous cell cervical carcinoma undergoing radical radiotherapy. Patients and Methods Patients diagnosed with FIGO-2018 II to III squamous cell cervical cancer between December 2013 and December 2014 were analyzed retrospectively. The optimal cutoff point for tumor length and width were determined by R package. We identified prognostic factors by univariate and multivariate Cox proportional-hazard regression, then built a nomogram to visualize the prediction model. Our model was compared to the 2018 FIGO staging prediction model. Harrell’s concordance index, receiver operating characteristic curve, calibration plot were used to evaluate the discriminability and accuracy of the predictive models, and decision curve analysis (DCA) was used to show the net benefits. Results Data from 469 patients were included in the final analyses. The cutoff values of tumor length and width were 5.10 cm and 4.13 cm, respectively. Four independent prognostic variables—tumor length, tumor width, lower one-third vaginal involvement, and lymph node metastases—were used to establish the nomogram. The C-index of the nomogram was 0.71 (95%, CI = 0.66–0.77), which was better than that of the 2018 FIGO stage prediction model (C-index: 0.62, 95% CI = 0.58–0.66, p = 0.009). The calibration plot of the nomogram was a good fit for both 3-year and 5-year overall survival predictions. And DCA curves showed that net benefits for our model were higher than FIGO-2018 staging system. Conclusion A clinically useful nomogram for calculating overall survival probability in FIGO-2018 II to III squamous cell cervical cancer patients who had received radical radiotherapy was developed. Tumor length, tumor width, lower one-third vaginal involvement, and lymph node metastases were found to be independent prognostic factors. Our model performed better than the 2018 FIGO staging model. The findings could help clinicians in China to predict the survival of these patients in clinical care and research.

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“…The median 5-year survival rate of patients without lymph node metastasis varies between 80% and 100%, whereas for patients with pelvic lymph node metastasis and paraaortic lymph node metastasis, the median 5-year survival rate goes from 57% to 78% and from 47% to 78%, respectively ( 19 , 20 ). Moreover, Kilic et al found that the number of positive metastatic lymph nodes may have an effect on survival; the 5-year recurrence-free survival (RFS) was 77% in patients with 5 or fewer positive metastatic lymph nodes, 51% in patients with 6–10 positive metastatic lymph nodes, and 37% in patients with 11 or more positive metastatic lymph nodes ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of Novel Nomograms to Predict the Overall Survival and Cancer-Specific Survival of Cervical Cancer Patients With Lymph Node Metastasis

Liu

Wang³

et al. 2022

Front. Oncol.

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ObjectiveThe objective of this study was to establish and validate novel individualized nomograms for predicting the overall survival (OS) and cancer-specific survival (CSS) in cervical cancer patients with lymph node metastasis.MethodsA total of 2,956 cervical cancer patients diagnosed with lymph node metastasis (American Joint Committee on Cancer, AJCC N stage=N1) between 2000 and 2018 were included in this study. Univariate and multivariate Cox regression models were applied to identify independent prognostic predictors, and the nomograms were established to predict the OS and CSS. The concordance index (C-index), calibration curves, and receiver operating characteristic (ROC) curves were applied to estimate the precision and discriminability of the nomograms. Decision-curve analysis (DCA) was used to assess the clinical utility of the nomograms.ResultsTumor size, log odds of positive lymph nodes (LODDS), radiotherapy, surgery, T stage, histology, and grade resulted as significant independent predictors both for OS and CSS. The C-index value of the prognostic nomogram for predicting OS was 0.788 (95% CI, 0.762–0.814) and 0.777 (95% CI, 0.758–0.796) in the training and validation cohorts, respectively. Meanwhile, the C-index value of the prognostic nomogram for predicting CSS was 0.792 (95% CI, 0.767–0.817) and 0.781 (95% CI, 0.764–0.798) in the training and validation cohorts, respectively. The calibration curves for the nomograms revealed gratifying consistency between predictions and actual observations for both 3- and 5-year OS and CSS. The 3- and 5-year area under the curves (AUCs) for the nomogram of OS and CSS ranged from 0.781 to 0.828. Finally, the DCA curves emerged as robust positive net benefits across a wide scale of threshold probabilities.ConclusionWe have successfully constructed nomograms that could predict 3- and 5-year OS and CSS of cervical cancer patients with lymph node metastasis and may assist clinicians in decision-making and personalized treatment planning.

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Recurrence pattern and prognostic factors for survival in cervical cancer with lymph node metastasis

Cited by 15 publications

References 22 publications

Analysis of Treatment Outcomes and Prognosis After Concurrent Chemoradiotherapy for Locally Advanced Cervical Cancer

Analysis of Treatment Outcomes and Prognosis After Concurrent Chemoradiotherapy for Locally Advanced Cervical Cancer

Nomogram Predicting Overall Survival in Patients with FIGO II to III Squamous Cell Cervical Carcinoma Under Radical Radiotherapy: A Retrospective Analysis Based on 2018 FIGO Staging

Development and Validation of Novel Nomograms to Predict the Overall Survival and Cancer-Specific Survival of Cervical Cancer Patients With Lymph Node Metastasis

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