Prediction of recurrence-related factors for patients with early-stage cervical cancer following radical hysterectomy and adjuvant radiotherapy

Gui-Fen Ma; Gen-Lai Lin; Si-Tong Wang; Ya-Yu Huang; Chun-Li Xiao; Jing Sun; Ting-Yan Shi; Li-Bing Xiang

doi:10.1186/s12905-023-02853-8

Prediction of recurrence-related factors for patients with early-stage cervical cancer following radical hysterectomy and adjuvant radiotherapy

BMC Womens Health. 2024 Jan 31;24(1):81. doi: 10.1186/s12905-023-02853-8.

Authors

Gui-Fen Ma¹, Gen-Lai Lin², Si-Tong Wang¹, Ya-Yu Huang³, Chun-Li Xiao¹, Jing Sun¹, Ting-Yan Shi⁴, Li-Bing Xiang⁴

Affiliations

¹ Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
² Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. lin.genlai@zs-hospital.sh.cn.
³ Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Xiamen Branch, Fujian, 361000, China.
⁴ Department of Gynecological Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.

Abstract

Objective: To analyze recurrent factors in patients with clinical early-stage cervical cancer (ESCC) following hysterectomy and adjuvant radiotherapy.

Methods: We collected data from patients with ESCC, staged according to the 2009 Federation International of Gynecology and Obstetrics (FIGO) staging criteria, who underwent hysterectomy followed by adjuvant radiotherapy between 2012 and 2019. These patients were subsequently restaged using the 2018 FIGO criteria. Univariable and multivariable analyses, along with nomogram analyses, were conducted to explore factors associated with recurrence-free survival (RFS).

Results: A total of 310 patients met the inclusion criteria, with a median follow-up time of 46 months. Among them, 126 patients with ESCC were restaged to stage III C1 or III C2 after surgery due to lymph node metastasis (LNM) based on the 2018 FIGO staging criteria. Of these, 60 (19.3%) experienced relapse. The 1-, 3-, and 5-year RFS rates were 93.9%, 82.7%, and 79.3%, respectively. Multivariate analysis revealed that the number of positive lymph nodes (LNs), tumor diameter (TD) > 4 cm, and parametrial invasion (PI) were associated with recurrence. The nomogram indicated their predictive value for 3-year and 5-year RFS. Notably, the 5-year recurrence rate (RR) increased by 30.2% in patients with LNM, particularly those with ≥ 3 positive LNs (45.5%). Patients with stage III C2 exhibited a significantly higher RR than those with IIIC1 (56.5% vs. 24.3%, p < 0.001). The 5-year RFS for patients with TD > 4 cm was 65.8%, significantly lower than for those with TD ≤ 4 cm (88.2%). Subgroup analysis revealed higher 5-year RRs in patients with stage III C2 than that in patients with III-C1 (56.5% vs. 24.3%, p < 0.001), demonstrating a significant difference in the RFS survival curve.

Conclusion: RR in patients with clinical ESCC after hysterectomy followed by adjuvant radiotherapy is correlated with the number of positive LNs, TD > 4 cm, and PI. Emphasis should be placed on the common high-risk factor of LNM association with recurrence after radical hysterectomy in ESCC.

Keywords: Adjuvant radiotherapy; Early-stage cervical cancer; Radical hysterectomy; Recurrence rate; Recurrence-free survival.

MeSH terms

Disease-Free Survival
Female
Humans
Hysterectomy
Lymph Node Excision
Neoplasm Recurrence, Local / pathology
Neoplasm Staging
Radiotherapy, Adjuvant
Retrospective Studies
Treatment Outcome
Uterine Cervical Neoplasms* / pathology