Effect of different therapeutic methods on survival of stage I-IIA cervical cancer patients complicated with postoperative intermediate risk factors

Abstract

Objective To compare the effect of different therapeutic methods upon the survival of stage Ⅰ-ⅡA cervical cancer patients with intermediate risk factors and explore the optimal treatment for patients with early-stage cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy. Methods Clinical data of 323 patients with the following intermediate risk factors of lymphovascular space invasion, depth of stromal invasion or tumor size>4 cm were retrospectively analyzed. The impact of observing (NT), chemotherapy (CT), radiotherapy (RT) and concurrent chemoradiotherapy (CCRT) on survival was statistically compared. The Kaplan-Meier method was used to survival analysis, and log-rank test difference, Cox model was used to prognostic factor analysis. Results The 5-year progression-free survival (PFS) and overall survival (OS) of all patients were 79.0% and 84.8%. Univariate and multivariate analyses demonstrated that TS> 4 cm and therapeutic method were the independent prognostic factors of PFS. The number of risk factors and therapeutic method were the independent prognostic factors of OS. In the whole group, both RT and CCRT could improve the prognosis of patients with no statistical significance (P>0.05). In the subgroup analysis, for patients with a single intermediate risk factor (low risk group), CT could significantly prolong the PFS (P=0.026) rather the 5-year OS (P=0.692). Compared with NT and CT, RT and CCRT could improve the PFS and OS, whereas no statistical significance was noted between the RT and CCRT (both P>0.05). For those with ≥2 risk factors (high risk group), CCRT could significantly prolong the PFS compared with CT (84.9% vs. 70%; P=0.006), but did not improve the OS (P=0.107). Compared with RT, CCRT could significantly improve the PFS and OS (both P<0.05). Conclusion For patients with only one risk factor, RT can enhance the clinical prognosis. CCRT can improve the clinical prognosis of stage Ⅰ-ⅡA cervical cancer patients with ≥2 risk factors. Key words: Cervical neoplasms/radiotherapy; Cervical neoplasms/chemotherapy; Cervical neoplasms/ concurrent chemoradiotherapy; Prognosis