Abstract
ObjectiveThe effectiveness of various strategies for the post-treatment monitoring of cervical cancer is unclear. This pilot study was conducted to explore recurrence patterns in and diagnostic strategies for patients with uterine cervical cancer who were meticulously followed using a customized monitoring plan.MethodsThe epidemiological and clinical data of patients with recurrent cervical cancer treated from March 2012 to April 2018 at a tertiary teaching hospital were retrospectively collected. The diagnostic methods and their reliability were compared across patients with various clinicopathological characteristics and were associated with survival outcomes.ResultsTwo hundred sixty-four patients with recurrent cervical cancer were included in the study, among which recurrence occurred in the first three years after the last primary treatment in 214 patients (81.06%). Half of the recurrence events (50.76%) occurred only within the pelvic cavity, and most lesions (78.41%) were multiple in nature. Among all recurrent cases, approximately half were diagnosed based on clinical manifestations (n=117, 44.32%), followed by imaging examinations (n=76, 28.79%), serum tumor markers (n=34, 12.88%), physical examinations (n=33, 12.50%) and cervical cytology with or without high-risk human papillomavirus (hrHPV) testing (n=4, 1.52%). The reliability of the diagnostic methods was affected by the stage (p<0.001), primary treatment regimen (p=0.001), disease-free survival (p=0.022), recurrence site (p=0.002) and number of recurrence sites (p=0.001). Primary imaging methods (sonography and chest X-ray) were not inferior to secondary imaging methods (computed tomography, magnetic resonance imaging and positron emission tomography-computed tomography) in the detection of recurrence. The chest X-ray examination only detected three cases (1.14%) of recurrence. Patients assessed with various diagnostic strategies had similar progression-free and overall survival outcomes.ConclusionsA meticulous evaluation of clinical manifestations might allow recurrence to be discovered in a timely manner in most patients with cervical cancer. Specific diagnostic methods for revealing recurrence were not associated with the survival outcomes.
Highlights
Uterine cervical cancer is one of most common causes of female cancer-related death among women worldwide [1]
264 patients with recurrent cervical cancer were enrolled at the study center (Table 1), who were treated for their primary diseases at our center and accepted a meticulous surveillance protocol since
One patient (0.38%) underwent chemotherapy as the initial treatment. Among those 176 patients who underwent surgery as the initial treatment, abdominal and minimally invasive surgeries accounted for 59.09% (n=104) and 40.91% (n=72), respectively, of treatments
Summary
Uterine cervical cancer is one of most common causes of female cancer-related death among women worldwide [1]. According to a conservative estimate, in 2015, 98,900 and 30,500 cases of incident cervical cancer and related mortality, respectively, occurred in China [2], accounting for one-fifth of the total number of new cases of cervical cancer worldwide [3]. The recurrence rates of International Federation of Gynecology and Obstetrics (FIGO) stage IB-IIA and IIB-IVA cervical cancer are 11% to 22% and 28% to 64%, respectively [4]. The aim of surveillance is to detect relapse at a stage when salvage treatment has the best chance of being effective and to monitor and treat treatment-related toxicity after the last primary treatment, since approximately 50% and 75% of cervical cancer recurrence cases occur within the first one and two years after primary treatment, respectively [9, 10]
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