Survival, treatment pattern, and treatment outcome in patients with cervical cancer metastatic to distant lymph nodes

Abstract

BackgroundCervical cancer with nodal involvement beyond the pelvis was considered as distant nodal metastasis in the previous International Federation of Gynecology and Obstetrics staging system. With the improvement of cancer-directed therapies, some of these patients can receive curative treatment. Classifying them as distant metastasis may result in underestimation of their prognosis as well as undertreatment. However, limited research has been conducted on the survival and treatment pattern in distant lymphatic metastatic cervical cancer.ObjectiveTo investigate the survival, treatment pattern, and treatment outcome of patients with cervical cancer metastasized to distant lymph nodes (DLN) beyond the pelvis.MethodsPatients with stage III-IV cervical cancer from 1988 to 2016 were identified using the Surveillance, Epidemiology, and End Results program. The cancer cause-specific survival (CSS) was analyzed using the Kaplan-Meier method, log-rank test, multivariable Cox proportional hazard regression, subgroup analysis, and propensity score-matched analysis.ResultsOf 17783 patients with stage III-IV cervical cancer, patients with distant nodal disease beyond the pelvis (n=1883; included para-aortic lymph nodes metastasis) had superior survival compared to those with pelvic organ invasion or with distant organ(s) metastasis (5-year CSS, 32.3%, 26.3%, and 11.5%, respectively; adjusted P<0.001). The T stage significantly affected the survival of patients with positive DLN (5-year CSS for T1, T2, and T3: 47.3%, 37.0%, and 19.8%, respectively, adjusted P<0.01). For patients with positive DLN, combination radiotherapy (external beam radiotherapy [EBRT] with brachytherapy) prolonged CSS compared to EBRT alone (5-year CSS, 38.0% vs 21.7%; propensity score-adjusted HR, 0.60; 95% CI 0.51-0.72; P<0.001). Despite the superiority of combination radiotherapy, EBRT was the most frequently used treatment after 2004 (483/1214, 39.8%), while the utilization of combination radiotherapy declined from 37.8% (253/669) during 1988 through 2003 to 25.2% (306/1214) during 2004 through 2016.ConclusionPatients with cervical cancer metastasized to DLN have favorable survival compared to those with pelvic organ invasion or with distant organ(s) metastasis. Their prognosis is significantly affected by local tumor burden and local treatment. Adequate and aggressive local radiotherapy, such as image-guided brachytherapy, can be considered for these patients to achieve better outcomes.

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.…”

“…Surgery may or may not be used to treat cervical cancer. Despite these multiple therapeutic options, the prognosis for patients presenting with metastatic disease remains poor [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Definitive surgery is likely never a major consideration for patients with metastatic cervical cancer.…”

Prevalence and epidemiological profile of cervical cancer patients attending Nyeri County and Referral Hospital, Kenya: a review of records 2017 – 2022.

“…Three modes of treatment were given to cervical cancer patients in this study which included surgery, chemotherapy and radiotherapy, but none showed signi cant association with survival rate although the treatment details of each mode were not available for analysis and comparison. The three modes are the recommended treatment depending on extent of the cervical cancer (Lin et al, 2022). This study's ndings highlight the prevalence, survival outcome, factors associated with survival among cervical cancer patients for ve years from year 2017 to year 2022.…”

Survival outcomes of 2018 FIGO stage IIIC versus stages IIIA and IIIB in cervical cancer: A systematic review with meta‐analysis

“…Lin et al. demonstrated that the deterioration of CSS rates was accompanied by an increase of T stage in stage IIIC2 ( P < 0.001) 30 . A Korean study reported that IIIC1r with pelvic side wall invasion (T3b) had approximately 3.8‐fold increased risk of mortality compared with those without this condition 14 .…”

“…23 Lin et al demonstrated that the deterioration of CSS rates was accompanied by an increase of T stage in stage IIIC2 (P < 0.001). 30 A Korean study reported that IIIC1r with pelvic side wall invasion (T3b) had approximately 3.8-fold increased risk of mortality compared with those without this condition. 14 Additionally, many studies have consistently demonstrated that compared with stage IIIC1 with one to two PLNMs, stage IIIC1 with three or more PLNMs has significantly worse survival outcome.…”