Special Focus on Stage IV Cervical Cancer Patients: A Decade Experience

Abstract

<b><i>Objectives:</i></b> The aim of this study was to identify and compare prognostic factors, management strategies, and outcomes of very locally advanced cervical cancer (CC) (i.e., stage IVA) and metastatic CC (i.e., stage IVB). <b><i>Method:</i></b> A retrospective review was conducted based on all consecutive patients treated<b><i></i></b>for stage IV CC in a comprehensive cancer care centre between 2004 and 2017. <b><i>Results:</i></b> Sixty-eight patients were included. Performance status (PS) was ≥2 for 35.9%. Median age at diagnosis was 60.5. There were 24 stage IVA CC (35.3%) and 44 stage IVB CC (64.7%). Seventeen patients with stage IVB CC had only para-aortic lymph node metastases (38.6%), 13 had only distant metastases (29.5%), and 14 had both (31.8%). Patients with stage IVA CC experienced a radiotherapy with curative intent (<i>n</i> = 14, 58.3%) +/– concomitant chemotherapy, or a palliative treatment (<i>n</i> = 10, 41.7%). Twenty-three patients with stage IVB CC received a prior chemotherapy (52.3%), 11 a primary concomitant chemoradiation (25%), and 10 a palliative treatment (22.7%). The mean follow-up was 18.0 months. The 5-year overall survival was 5.1% for stage IVA (95% CI = 0.7–33.9), and 10.5% for stage IVB (95% CI = 3.7–29.7). In multivariate analysis, PS >1 was identified as a poor prognostic factor of disease-specific survival for stage IVA CC. PS >1 and pelvic lymph node involvement were identified as poor prognostic factors of overall survival and disease-specific survival for stage IVB CC. <b><i>Conclusions:</i></b> In daily clinical practice, outcomes of stages IV CC are poor. Treatment of advanced and metastatic CC remains challenging. New management strategies are needed, as well as efficient preventive strategies.

Factors Affecting Survival Outcome After Percutaneous Nephrostomy as Palliative Urinary Diversion in Obstructive Uropathy due to Advance Cervical Cancer Patients

“…Survival rates are much lower in metastatic (stage IV) cervical cancer compared to lower stages. 5-year survival rates range from 5.1% to 25% for stage IV cervical cancer, compared to as high as 100% for stages IA and IB cervical cancer ( Jayant et al, 2016;Hu et al, 2017;Espenel et al, 2019). Obstructive uropathy is common in advanced cervical cancer, although kidney metastasis is comparatively rare (Fan et al, 2015).…”

Cervix-Online computer program: 27 years of hospital-based clinical registry for cervical cancer at the University Medical Centre Maribor

“…Cystoscopy and proctoscopy are allowed for staging purposes and can reveal a tumour spread into these organs categorizing the patient into the IVA stage with poor treatment results. 32 The treatment part of the inquiry includes surgery, radiotherapy, chemotherapy, and hormonal therapy. Details about each type of treatment are listed in the Treatment section along with the most common complications.…”

“…Cystoscopy and proctoscopy are allowed for staging purposes and can reveal a tumour spread into these organs categorizing the patient into the IVA stage with poor treatment results. 32 …”

<p>The Combined Use of Chemotherapy and Radiotherapy with PD-1 Inhibitor, Pembrolizumab, in Advanced Cervical Cancer: A Case Report</p>

“…19 After discussing with a multidisciplinary team, a more specific and adapted treatment can be sought. 20 However, the prognosis of stage IVB cervical cancer patients remains poor, with 5-year overall survival of about 10%. 20 The advent of PD1/PD-L1 inhibitors breaks through the therapeutic bottle neck and may change the traditional treatment model.…”

“…20 However, the prognosis of stage IVB cervical cancer patients remains poor, with 5-year overall survival of about 10%. 20 The advent of PD1/PD-L1 inhibitors breaks through the therapeutic bottle neck and may change the traditional treatment model. 9,21 The combination of chemotherapy and immunotherapy has been shown to improve treatment effects.…”