Impact of different therapies on the survival of patients with stage I-IIA cervical cancer with intermediate risk factors

Efficacy and safety of chemotherapy as monotherapy in patients with recurrent intermediate/high-risk factors following radical hysterectomy for stage IB-IIA cervical cancer: a single-center retrospective analysis

OBJECTIVE

The aim of this study is to explore the efficacy and safety of chemotherapy (CT) as a monotherapy in patients with recurrent intermediate/high-risk factors following radical hysterectomy for stage IB-IIA cervical cancer.

METHODS

A retrospective analysis was conducted on the medical records of patients diagnosed with stage IB-IIA cervical cancer who underwent radical hysterectomy at the People's Hospital of Suzhou High-tech District between 2010 and 2020. A total of 66 patients with intermediate or high-risk factors for recurrence were treated exclusively with CT. This cohort included 42 patients in the intermediate-risk group and 24 in the high-risk group. Treatment protocols consisted of 4-6 cycles of paclitaxel and cisplatin drugs for the intermediate-risk group, and 6 cycles for the high-risk group. The relapse-free survival (RFS), recurrence rates, and common CT-related adverse reactions, including bone marrow suppression, nausea and vomiting, and diarrhea, were assessed for both groups.

RESULTS

(1) The cumulative 3-year RFS rates for the intermediate-risk and high-risk groups were 97.3% (36/37) and 82.4% (14/17), respectively, with cumulative 5-year RFS rates of 97.1% (34/35) and 82.4% (14/17), respectively. The Log rank test revealed no significant difference between the two groups (P > 0.05), (χ² = 2.718, P = 0.099). The 5-year recurrence rates in the intermediate-risk and high-risk groups were 2.38% (1/42) and 12.50% (3/24), respectively. (2) The incidence of grade III bone marrow suppression in the intermediate-risk and high-risk groups was 21.19% (11/42) and 25.00% (6/24), respectively, while the incidence of grade IV bone marrow suppression was 11.90% (5/42) and 8.33% (2/24), respectively. There was no statistically significant difference in bone marrow suppression grades between the two groups (P > 0.05).

CONCLUSION

CT with paclitaxel and cisplatin, administered as monotherapy post-radical hysterectomy for stage IB-IIA cervical cancer, demonstrates satisfactory survival benefits with an acceptable safety profile. Moreover, no significant differences were observed in prognosis or adverse reactions between the different risk groups treated solely with CT.

The impacts of minimally invasive surgery on intermediate- or high-risk cervical cancer patients received adjuvant radiotherapy

BACKGROUND

Adjuvant chemoradiotherapy (CRT) has been shown to reduce the risk of recurrence for patients with risk factors after radical hysterectomy (RH). Early initiated CRT could result in superior oncological outcomes. Here, we aimed to compare the survival outcome of intermediate- or high-risk cervical cancer (CC) patients who, received adjuvant CRT between minimally invasive surgery (MIS) and open surgery.

METHODS

Data on stage IB1-IIA2 patients who underwent RH and postoperative CRT in our institution, from 2014 to 2017, were retrospectively collected. Patients with high or intermediate-risk factors who met the Sedlis criteria received sequential chemoradiation (SCRT). According to the surgical approaches, the enrolled patients were divided into MIS and open surgery groups. Then, the disease-free survival (DFS), overall survival (OS), and prognostic factors were analyzed.

RESULTS

Among 129 enrolled CC patients, 68 received open surgery and 61 received MIS. The median time interval from surgery to chemotherapy and to radiotherapy was shorter in the MIS group (7 days vs. 8 days, P=0.014; 28 days vs. 35, P<0.001). Three-year DFS and OS were similar in both groups (85.2% vs. 89.7%, P=0.274; 89.9% vs. 98.5%, P=0.499). Further, sub-analysis indicated that the DFS and OS in intermediate/high-risk groups had no significant difference. Cox-multivariate analyses found that tumor size >4 cm and time interval from surgery to radiotherapy beyond 7 weeks were adverse independent prognostic factors for DFS.

CONCLUSION

Based on the population we studied, for early-stage (IB1-IIA2) CC patients with intermediate- or high-risk factors who received postoperative SCRT, although the difference was not significant, the DFS and OS in the MIS group were slightly lower than the ORH group, and tumor size >4 cm and delayed adjuvant radiotherapy beyond 7 weeks were risk factors for recurrence.

Significance of the Number of Intermediate-Risk Factors in Cervical Cancer Patients Treated with Radical Hysterectomy: A Retrospective Study of 976 Patients

BACKGROUND AND OBJECTIVES

This study aimed to investigate the impact of intermediate-risk factors (IRFs) on the prognosis of stage I-II cervical cancer (CC) patients, and evaluate the necessity of adjuvant treatment based on investigation.

METHODS

Medical records of 976 negative high-risk factors' CC patients were retrospectively reviewed. Clinicopathologic characteristics and adjuctive therapy were analyzed using Kaplan-Meier analysis and log-rank tests to identify significant factors. The multivariate Cox proportional hazards regression analysis was performed to identify the independent prognostic factors.

RESULTS

For patients with none, single and multiple IRFs, the 3-year recurrence-free survival rates were 97.8%, 86.3%, and 68.0% respectively (p < 0.001), and 3-year overall survival rates were 99.3%, 93.6% and 79.0% respectively (p < 0.001). Multivariate analysis showed histological type, differentiation grade, the number of IRFs and adjuvant therapy were independent prognostic factors.

CONCLUSIONS

The number of IRFs was demonstrated with higher predictive efficacy on survival of CC than individual IRF. Patients with multiple IRFs had significantly worse survival outcomes than patients with none or one. Different adjuvant treatment plans should be formulated based on the number of present IRFs. The prognostic management of patients with multiple IRFs should be pay more attention.

The positive threshold of the immunohistochemical parameter Ki67 for predicting the recurrence of cervical cancer

OBJECTIVE

To find the optimal threshold of Ki67 and evaluate its significance in predicting recurrence of stage I-II cervical cancer.

METHODS

A total of 1130 patients were included after screening. Univariate and multivariate Cox regression analysis were used to select factors associated with recurrence of cervical cancer. The receiver operating characteristic (ROC) curve was used to assess the optimal threshold of Ki67. The differences of clinicopathological parameters and the survival analysis between the two groups divided based on the optimal threshold of Ki67 were compared.

RESULTS

Multivariate Cox regression analysis showed that Ki67 (p < 0.001) was significant prognostic predictor for recurrence of cervical cancer. The optimal threshold of Ki67 was 42%. The recurrence-free survival (RFS) and the overall survival (OS) of cervical cancer patients in the high-Ki67 group (Ki67≥42%) were much lower than those in the low-Ki67 group (Ki67<42%) (p < 0.001, p < 0.001). Among the 380 patients with low-risk cervical cancer, the RFS and OS of patients in the high-Ki67 group were also lower than those in the low-Ki67 group (p < 0.001, p < 0.001).

CONCLUSION

The Ki67 was a useful prognostic factor in patients with stage I-II cervical cancer, and the Ki67 labeling index 42.0% was optimal threshold for predicting recurrence.