Role of locoregional surgery in treating FIGO 2009 stage IVB cervical cancer patients: a population-based study

Abstract

ObjectiveWe aimed to analyse the clinical value of primary site surgery in improving the cancer-specific survival (CSS) and overall survival (OS) of initial metastatic cervical cancer patients.DesignA population-based retrospective study.SettingNational Cancer Institute’s Surveillance, Epidemiology and End Results database.ParticipantsWe analysed 1390 patients with the International Federation of Gynecology and Obstetrics 2009 stage IVB cervical cancer with complete clinical data treated between 2010 and 2016.InterventionsPrimary site surgery.MeasuresPropensity score matching (PSM) with a ratio of 1:2 was used to balance measure covariates of comparison groups. Survival time was calculated using Kaplan-Meier methods and compared by the log-rank test. To eliminate the bias of site-specific metastasis, clinicopathological factors and subsequent therapy on survival analysis, subgroup analyses stratified by metastasis type, clinicopathological factors and subsequent therapy were employed to evaluate the effect of cervical surgery on survival. Combination of directed acyclic graph and change-in-estimate procedures was performed to indentified confounders, and Cox regression was used to assess the survival benefit of cervical surgery for primary metastatic cervical cancer patients. The consistency of our findings was evaluated through sensitivity analysis.ResultsMatching resulted in two comparison groups with minor differences in most variables. Pre-and-post-PSM, the median CSS and OS in the surgery group were 1.3 and 1.5, 1.1 and 1.2 times of those in the non-surgery group, respectively. Primary site surgery conferred prognosis superiority for patients with metastases to distant lymph node and other sites rather than organ metastases. After PSM and adjusting confounders, local surgery reduced the cancer related and overall mortality rates by 31% and 30%, respectively.ConclusionsSurgical procedures could promote survival in patients with primary metastatic cervical cancer and should be considered a therapeutic option for carefully chosen patients.

Immuno-Molecular Targeted Therapy Use and Survival Benefit in Patients with Stage IVB Cervical Carcinoma in Commission on Cancer®-Accredited Facilities in the United States

“…This study also provides additional insights regarding the factors that impact the utilization of IMT in patients with stage IVB cervical cancer compared with prior studies [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 17 , 19 , 21 , 24 , 25 , 30 , 48 , 49 , 50 , 51 , 52 , 53 ]. We found that patients with Medicaid insurance or no insurance, older age, or either distant lymph node or distant organ metastasis but not with both, and those treated at Non-Academic/Research Facilities or with CT + EBRT ± ICBT were significantly less likely to receive IMT.…”

Effect of primary radiotherapy on the survival rate of stage IVB cervical cancer patients and factors related to their survival: a real-world study based on SEER database

“…Lastly, animal models indicated that reducing the cells in the core lesion via radical topical therapy might reverse tumor-associated immunosuppression [25]. There is now increasing evidence showing that the local treatment (radiotherapy or surgery) of the primary lesion could prolong the survival of metastatic cervical cancer [26][27][28][29][30][31] and decrease the mortality rate by nearly 30%, the median survival was 3 to 4 months longer [26,27,32]. However, surgery might not be suitable for all patients.…”

Combined modality management of advanced cervical cancer including novel sensitizers

“…Consideration can be given to resection of metastatic foci on a case-by-case basis, depending on factors such as the presence of symptoms, number of metastatic foci, feasibility of treatment, and response to chemotherapy. Primary site surgery has also been shown to improve survival of patients with non-visceral distant metastasis 10…”

“…Primary site surgery has also been shown to improve survival of patients with non-visceral distant metastasis. 10…”