Clinical Aspects and Prognostic Factors for Survival in Patients with Recurrent Cervical Cancer after Radical Hysterectomy

Clinical Outcomes and Their Prognostic Factors among Cervical Cancer Patients with Bone Recurrence

Background

Bone recurrence occurs in 0.75%-8% of cervical cancer patients after primary treatment. Only a few previous studies have reported on survival times associated with prognostic factors for bone recurrent cervical cancer. This study aimed to evaluate the oncological outcomes and their predictors among cervical cancer patients with bone recurrence.

Methods

The medical records of cervical cancer patients with bone recurrence who received primary treatment at Songklanagarind Hospital from January 2002 to December 2017 were retrospectively reviewed. Prognostic factors were identified using a Cox regression model.

Results

The study included 6,354 cervical cancer patients, of whom 98 (1.54%) had bone recurrence at a median time of 25 months after the primary treatment (range 4.9-136 months). The most frequent site of bone recurrence was the spine (81.00%); the two most common visceral coexisting recurrence sites were the lungs and the liver. The median recurrence-free interval (RFI) was 21 months. Of the patients with recurrence, 75 (76.50%) were treated with combined radiation therapy and chemotherapy. The one-year overall survival (OS) after recurrence was 22.70%. On multivariate analysis, age under 60 years at the time of recurrence diagnosis (hazard ratio [HR] = 2.48, 95% CI = 1.47-4.18, p=0.001) and an RFI less than 21 months (HR = 1.63, 95% CI = 1.04-2.55, p=0.03) were independent prognostic factors for OS after recurrence.

Conclusion

Bone recurrence in cervical cancer patients is rare and is associated with poor survival. Our study found that age and RFI were significant prognostic factors for OS in cervical cancer patients with bone recurrence.

Preoperative Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio Are Not Clinically Useful in Predicting Prognosis in Early Stage Cervical Cancer

Background

An objective of this study was to determine the prognostic role of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in patients with cervical cancer (CC) stages IA2-IB1.

Methods

The study included 484 patients who underwent radical hysterectomy with pelvic node dissection. The associations of preoperative NLR and PLR with clinicopathologic characteristics and oncological outcomes were analyzed. The cut-off values of NLR (=1.8) and PLR (=119) were set as medians.

Results

The clinicopathologic analysis showed that NLR was associated with age (p=0.010), tumor size (p=0.045), and adjuvant treatment (p=0.005), and PLR was associated with only adjuvant treatment (p=0.033). DFS and OS were not significantly different between patients with high and low NLR (p=0.670 and p=0.934) or high and low PLR (p=0.780 and p=0.306). The independent prognostic factors associated with OS were lymph node status and anemia, and with DFS were histology, deep stromal invasion, and lymph node status.

Conclusions

NLR and PLR have no use as prognostic biomarker for DFS and OS in early-stage CC. However, NLR and PLR might be of use in determining the risk for adjuvant treatment.

PET/CT imaging analysis of recurrent sites and patterns of spread following modified radical surgery (type B) for stage Ib-IIa cervical cancer

The aim of the present study was to use imaging to retrospectively analyze the recurrent sites and patterns of spread of early cervical cancer following radical surgery. A total of 86 patients with cervical cancer (stage IB or IIA) showed postoperative pelvic recurrences and distant metastases. Based on positron emission tomography or computed tomography, the correlation between clinicopathologic factors and sites of recurrence was determined and the pattern of spread was evaluated. Among the 86 patients with postoperative recurrence of early cervical cancer, 76 exhibited pelvic recurrence involving the cardinal and uterosacral ligaments. Other recurrences were paravaginal (n=14) and vaginal (n=10). Seven cases of recurrence were in the pelvic lymph nodes and 10 patients had distant metastases. The rate of paracervical ligament recurrence in patients with stromal invasion ≥1/2 depth was higher, compared with that in patients with stromal invasion <1/2 depth, however, the difference was not statistically significant. The rate of distant metastases in patients with positive pelvic lymph nodes was higher, compared with that in patients with negative lymph nodes (P=0.001). Recurrent lesions spread along the residual ligament to the lateral pelvic wall. It was found that, following radical surgery for early cervical cancer, recurrent tumor spread was predominantly confined to the subperitoneal residual ligaments of the cervix and vagina. For patients with positive lymph nodes, the incidence of distant metastases increased significantly.