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Zheng Z, Hu K, Hou X, Yu L, Yan J, Zhang F. Radiotherapy for postoperative vaginal recurrences of cervical squamous cell carcinoma: analysis of dosing and prognosis. J OBSTET GYNAECOL 2023; 43:2213328. [PMID: 37462369 DOI: 10.1080/01443615.2023.2213328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 04/16/2023] [Indexed: 07/21/2023]
Abstract
Squamous cell carcinoma (SCC) is the most common type of vaginal recurrence in cervical cancer patients, and the role of salvage radiotherapy on these patients remains unclear. This study aimed to investigate the efficacy of salvage radiotherapy for vaginal recurrence of SCC in patients who previously underwent surgery and to explore prognostic factors associated with survival. Ninety-seven patients with histologically proven SCC who were treated for vaginal recurrence at Peking Union Medical College Hospital were identified. All patients had previously undergone surgery and received salvage radiotherapy. Factors predictive of overall survival (OS), progression-free survival (PFS), and local control (LC) were investigated. The median follow-up time was 42.5 months. The estimated 5-year OS, PFS, and LC rates were 84%, 79%, and 91%. On multivariate analysis, inguinal lymph node metastasis was significantly associated with poor OS; a tumour size ≤4 cm was associated with longer PFS (p < 0.05); the recurrence pattern was an independent predictor of LC (p < 0.05). In the 45 patients with recurrences that were paravaginal or invasive of surrounding organs, biologically equivalent doses in 2 Gy fractions of ≥72.6 Gy were independently predictive of longer LC (p < 0.05). RT is an effective treatment for postoperative vaginal recurrence in patients with cervical SCC. For patients with extravaginal recurrence, a salvage dose of ≥72.6 Gy appears to be optimal.Impact statementWhat is already known on this subject? Radiotherapy plays a critical role in treating recurrent cervical cancer, but the effectiveness of RT for vaginal recurrence in patients who previously underwent surgery remains limited. Few studies have focussed on the effect of RT dose on patient survival.What do the results of this study add? This study investigated the efficacy of RT in patients with cervical squamous cell carcinoma who experienced postoperative recurrence. Lymph node metastasis, tumour size and recurrence pattern were significantly associated with survival. Moreover, an EQD2 ≥ 72.6 Gy was independently predictive of longer LC.What are the implications of these findings for clinical practice and/or further research? RT is an effective treatment for postoperative vaginal recurrence in patients with cervical squamous cell carcinoma. For patients with extravaginal recurrence, a salvage dose of ≥72.6 Gy appears to be optimal.
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Affiliation(s)
- Ziye Zheng
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lihua Yu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Junfang Yan
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
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Ye Y, Zhang G, Li Z, Chen B, Zhao H, Yang Y, Wang L, Yao J, Chen X, Huang Y, Lang J, Liu P, Chen C. Initial treatment for FIGO 2018 stage IIIC cervical cancer based on histological type: A 14-year multicenter study. Cancer Med 2023; 12:19617-19632. [PMID: 37768092 PMCID: PMC10587947 DOI: 10.1002/cam4.6586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/27/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND To compare the oncological outcomes of radical chemotherapy (R-CT), abdominal radical hysterectomy (ARH), and neoadjuvant chemotherapy and radical surgery (NACT) for International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIIC cervical cancer, according to histological types: squamous cell carcinoma (SCC) and adenocarcinoma (AC)/adenosquamous cell carcinoma (ASC). METHODS A comparison of 5-year overall survival (OS) and disease-free survival (DFS) was performed for the SCC and AC/ASC subgroups for the three initial treatments, assessed using Kaplan-Meier and Cox proportional hazards regression analysis and validated using propensity score matching (PSM). RESULTS The study included 4086 patients: R-CT, n = 1913; ARH, n = 1529; and NACT, n = 644. AC/ASC had a lower survival rate (63.7%) than SCC (73.6%) and a higher recurrence and mortality rate (36.3% and 26.4%, respectively). The 5-year OS and DFS rates were different in the SCC group for R-CT, ARH, and NACT (OS: 69.8% vs. 80.8% vs. 73.0%, p < 0.001; DFS: 66.7% vs. 70.7% vs. 56.4%, p < 0.001), also in the AC/ASC group (OS: 46.1% vs. 70.6% vs. 55.6%, p < 0.001; DFS: 42.7% vs. 64.6% vs. 40.8%, p < 0.001). As for initial treatment, survival outcomes were worse for AC/ASC treated with R-CT and ARH than for SCC (both p < 0.05), with no group differences between the two treated with NACT. CONCLUSION Initial treatment influences oncological prognosis for patients with FIGO 2018 stage IIIC cervical cancer. ARH is an alternative treatment for stage IIIC cervical SCC and AC/ASC, and NACT needs to be chosen with caution, moreover, R-CT for AC/ASC requires careful selection.
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Affiliation(s)
- Yanna Ye
- Department of Midwifery, Faculty of HealthDongguan PolytechnicDongguanChina
- Department of Obstetrics and Gynecology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Guochao Zhang
- Department of General SurgeryChina‐Japan Friendship HospitalBeijingChina
| | - Zhiqiang Li
- Department of Obstetrics and Gynecology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Biliang Chen
- Department of Obstetrics and GynecologyXijing Hospital of Airforce Medical UniversityXianChina
| | - Hongwei Zhao
- Department of Gynecologic OncologyShanxi Provincial Cancer HospitalTaiyuanChina
| | - Ying Yang
- Department of Obstetrics and Gynecology, Xinqiao HospitalArmy Medical UniversityChongqingChina
| | - Li Wang
- Department of Gynecologic Oncology, Affiliated Cancer HospitalZhengzhou UniversityZhengzhouChina
| | - Jilong Yao
- Department of Obstetrics and GynecologyShenzhen Maternal and Child Health HospitalShenzhenChina
| | - Xiaolin Chen
- Department of Obstetrics and Gynecology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Yahong Huang
- Department of Obstetrics and Gynecology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Department of Obstetrics and GynecologyPeking Union Medical College HospitalBeijingChina
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
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Duan H, Li H, Kang S, Zhao H, Chen B, Wang L, Li P, Wang Y, Wang W, Lang J, Liu P, Chen C. Rationality of FIGO 2018 IIIC restaging of cervical cancer according to local tumor size: A cohort study. Acta Obstet Gynecol Scand 2023; 102:1045-1052. [PMID: 37338046 PMCID: PMC10378020 DOI: 10.1111/aogs.14612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/14/2023] [Accepted: 05/25/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION FIGO 2018 IIIC remains controversial for the heterogeneity of its prognoses. To ensure a better management of cervical cancer patients in Stage IIIC, a revision of the FIGO IIIC version classification is required according to local tumor size. MATERIAL AND METHODS We retrospectively enrolled cervical cancer patients of FIGO 2018 Stages I-IIIC who had undergone radical surgery or chemoradiotherapy. Based on the tumor factors from the Tumor Node Metastasis staging system, IIIC cases were divided into IIIC-T1, IIIC-T2a, IIIC-T2b, and IIIC-(T3a+T3b). Oncologcial outcomes of all stages were compared. RESULTS A total of 63 926 cervical cancer cases were identified, among which 9452 fulfilled the inclusion criteria and were included in this study. Kaplan-Meier pairwise analysis showed that: the oncology outcomes of I and IIA were significantly better than of IIB, IIIA+IIIB, and IIIC; the oncology outcome of IIIC-(T1-T2b) was significantly better than of IIIA+IIIB and IIIC-(T3a+T3b); no significant difference was noted between IIB and IIIC-(T1-T2b), or IIIC-(T3a+T3b) and IIIA+IIIB. Multivariate analysis indicated that, compared with IIIC-T1, Stages T2a, T2b, IIIA+IIIB and IIIC-(T3a+T3b) were associated with a higher risk of death and recurrence/death. There was no significant difference in the risk of death or recurrence/death between patients with IIIC-(T1-T2b) and IIB. Also, compared with IIB, IIIC-(T3a+T3b) was associated with a higher risk of death and recurrence/death. No significant differences in the risk of death and recurrence/death were noted between IIIC-(T3a+T3b) and IIIA+IIIB. CONCLUSIONS In terms of oncology outcomes of the study, FIGO 2018 Stage IIIC of cervical cancer is unreasonable. Stages IIIC-T1, T2a, and T2b may be integrated as IIC, and it might be unnecessary for T3a/T3b cases to be subdivided by lymph node status.
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Affiliation(s)
- Hui Duan
- Department of Obstetrics and Gynecology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Huimin Li
- Department of Obstetrics and Gynecology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Shan Kang
- Department of GynecologyThe Forth Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Hongwei Zhao
- Department of Gynecologic OncologyShanxi Provincial Cancer HospitalTaiyuanChina
| | - Biliang Chen
- Department of Obstetrics and GynecologyXijing Hospital of Airforce Medical UniversityXi'anChina
| | - Li Wang
- Department of Gynecologic Oncology of Affiliated Cancer Hospital of Zhengzhou UniversityZhengzhouChina
| | - Pengfei Li
- Department of Obstetrics and Gynecology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Yahong Wang
- Department of Obstetrics and Gynecology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Wei Wang
- Department of Obstetrics and Gynecology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
- Department of Obstetrics and Gynecology, Peking Union Medical College HospitalPeking Union Medical CollegeBeijingChina
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
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Hu C, Cao J, Zeng L, Luo Y, Fan H. Prognostic factors for squamous cervical carcinoma identified by competing-risks analysis: A study based on the SEER database. Medicine (Baltimore) 2022; 101:e30901. [PMID: 36181049 PMCID: PMC9524987 DOI: 10.1097/md.0000000000030901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Cervical cancer has a high incidence of malignant tumors and a high mortality rate, with squamous cervical carcinoma (SCC) accounting for 80% of cases. A competing-risks model is recommended as being more feasible for evaluating the prognosis and guiding clinical practice in the future compared to Cox regression. Data originating from the Surveillance, epidemiology, and end results (SEER) database during 2004 to 2013 were analyzed. Univariate analysis with the cumulative incidence function was performed to assess the potential risk of each covariate. Significant covariates (P < .05) were extracted for inclusion in a Cox regression analysis and a competing-risks model that included a cause-specific (CS) hazard function model and a sub-distribution (SD) hazard function model. A total of 5591 SCC patients met the inclusion criteria. The three methods (Cox regression analysis, CS analysis, and SD analysis) showed that age, metastasis, American Joint Committee on Cancer stage, surgery, chemotherapy, radiation sequence with surgery, lymph node dissection, tumor size, and tumor grade were prognostic factors affecting survival in patients with SCC. In contrast, race and radiation status were prognostic factors affecting survival in the Cox regression and CS analysis, but the results were different in the SD analysis. Being separated, divorced, or widowed was an independent prognostic factor in the Cox regression analysis, but the results were different in the CS and SD analyses. A competing-risks model was used as a new statistical method to more accurately identify prognostic factors than conventional Cox regression analysis leading to bias in the results. This study found that the SD model may be better suited to estimate the clinical prognosis of a patient, and that the results of an SD model analysis were close to those of a CS analysis.
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Affiliation(s)
- Chengfeng Hu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Junyan Cao
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
- Guizhou University of Traditional Chinese Medicine, Guiyang, China
- *Correspondence: Junyan Cao, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang 550003, China (e-mail: )
| | - Li Zeng
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Yao Luo
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Hongyuan Fan
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
- Guizhou University of Traditional Chinese Medicine, Guiyang, China
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Song T, Xu H, Shi L, Yan S. Prognostic Analysis and Comparison of the 2014 and 2018 International Federation of Gynecology and Obstetrics Staging System on Overall Survival in Patients with Stage IIB-IVA Cervix Carcinoma. Int J Womens Health 2022; 14:333-344. [PMID: 35283649 PMCID: PMC8909488 DOI: 10.2147/ijwh.s348074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/25/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose This study aimed to assess the prognostic factors of overall survival (OS) in patients with stage IIB–IVA cervix carcinoma (CC) who underwent external beam radiation therapy (EBRT) and brachytherapy (BRT) and to compare the prognostic accuracy of the 2014 and 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system using the Surveillance, Epidemiology, and End Results (SEER) database. Methods Patients with a histopathological diagnosis of CC between 2004 and 2016 were included. The primary endpoint was OS. The prognostic significance for OS was analyzed by the Cox regression model. Prognostic accuracy in evaluating 3- and 5-year OS in different staging systems was evaluated using time-dependent receiver operating characteristic (tdROC) curves. Results A total of 2585 patients with stage IIB–IVA CC, staged according to the 2014 FIGO staging system, were included in the study. The 3- and 5-year OS rates were 63.9% and 56.6%, respectively, with a median OS of 98 months. Independent variables, such as older age at diagnosis, histological grades apart from well or moderately differentiated, large tumor size, advanced tumor stages classified according to the 2014 and 2018 FIGO staging systems and treatment without chemotherapy or unknown were associated with a worse OS. A tdROC analysis conducted using DeLong’s tests revealed no significant difference in the prediction of 3- and 5-year OS between the 2014 and 2018 FIGO staging systems (P = 0.912 and 0.863, respectively). Conclusion Both 2014 and 2018 FIGO staging systems were strong prognostic factors for OS. No significant risk classification was observed for stage IIIC1 disease in the revised 2018 FIGO staging system for patients who underwent EBRT and BRT.
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Affiliation(s)
- Tao Song
- Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, People's Republic of China.,Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Hong'en Xu
- Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Lei Shi
- Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Senxiang Yan
- Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, People's Republic of China
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Ding D, Lang T, Zou D, Tan J, Chen J, Zhou L, Wang D, Li R, Li Y, Liu J, Ma C, Zhou Q. Machine learning-based prediction of survival prognosis in cervical cancer. BMC Bioinformatics 2021; 22:331. [PMID: 34134623 PMCID: PMC8207793 DOI: 10.1186/s12859-021-04261-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/11/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Accurately forecasting the prognosis could improve cervical cancer management, however, the currently used clinical features are difficult to provide enough information. The aim of this study is to improve forecasting capability by developing a miRNAs-based machine learning survival prediction model. RESULTS The expression characteristics of miRNAs were chosen as features for model development. The cervical cancer miRNA expression data was obtained from The Cancer Genome Atlas database. Preprocessing, including unquantified data removal, missing value imputation, samples normalization, log transformation, and feature scaling, was performed. In total, 42 survival-related miRNAs were identified by Cox Proportional-Hazards analysis. The patients were optimally clustered into four groups with three different 5-years survival outcome (≥ 90%, ≈ 65%, ≤ 40%) by K-means clustering algorithm base on top 10 survival-related miRNAs. According to the K-means clustering result, a prediction model with high performance was established. The pathways analysis indicated that the miRNAs used play roles involved in the regulation of cancer stem cells. CONCLUSION A miRNAs-based machine learning cervical cancer survival prediction model was developed that robustly stratifies cervical cancer patients into high survival rate (5-years survival rate ≥ 90%), moderate survival rate (5-years survival rate ≈ 65%), and low survival rate (5-years survival rate ≤ 40%).
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Affiliation(s)
- Dongyan Ding
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Bioengineering College, Chongqing University, Chongqing, 400044, People's Republic of China
- Department of Gynecologic Oncology, School of Medicine, Chongqing University Cancer Hospital, , Chongqing University, Chongqing, 400030, People's Republic of China
| | - Tingyuan Lang
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Bioengineering College, Chongqing University, Chongqing, 400044, People's Republic of China.
- Department of Gynecologic Oncology, School of Medicine, Chongqing University Cancer Hospital, , Chongqing University, Chongqing, 400030, People's Republic of China.
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, School of Medicine, Chongqing University Cancer Hospital, Chongqing University, Chongqing, 400030, People's Republic of China.
| | - Dongling Zou
- Department of Gynecologic Oncology, School of Medicine, Chongqing University Cancer Hospital, , Chongqing University, Chongqing, 400030, People's Republic of China
| | - Jiawei Tan
- School of Mathematics and Statistics, Changchun University of Technology, Changchun, 130012, People's Republic of China
| | - Jia Chen
- School of Mathematics and Statistics, Changchun University of Technology, Changchun, 130012, People's Republic of China
| | - Lei Zhou
- Singapore Eye Research Institute, The academia, 20 College Road, Discovery Tower Level 6, Singapore, 169856, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Ophthalmology and Visual Sciences Academic Clinical Research Program, National University of Singapore, Singapore, Singapore
| | - Dong Wang
- Department of Gynecologic Oncology, School of Medicine, Chongqing University Cancer Hospital, , Chongqing University, Chongqing, 400030, People's Republic of China
| | - Rong Li
- Department of Gynecologic Oncology, School of Medicine, Chongqing University Cancer Hospital, , Chongqing University, Chongqing, 400030, People's Republic of China
| | - Yunzhe Li
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Bioengineering College, Chongqing University, Chongqing, 400044, People's Republic of China
- Department of Gynecologic Oncology, School of Medicine, Chongqing University Cancer Hospital, , Chongqing University, Chongqing, 400030, People's Republic of China
| | - Jingshu Liu
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Bioengineering College, Chongqing University, Chongqing, 400044, People's Republic of China
- Department of Gynecologic Oncology, School of Medicine, Chongqing University Cancer Hospital, , Chongqing University, Chongqing, 400030, People's Republic of China
| | - Cui Ma
- Department of Pediatric Hematology, First Hospital of Jilin University, Changchun, 130023, Jilin, People's Republic of China
| | - Qi Zhou
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Bioengineering College, Chongqing University, Chongqing, 400044, People's Republic of China.
- Department of Gynecologic Oncology, School of Medicine, Chongqing University Cancer Hospital, , Chongqing University, Chongqing, 400030, People's Republic of China.
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, School of Medicine, Chongqing University Cancer Hospital, Chongqing University, Chongqing, 400030, People's Republic of China.
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