Metastatic site-specific prognosis of women with stage IVB cervical cancer (345)

Abstract

Objectives: In patients with cervical cancer, evidence of tumor spread to organs distant from the uterine cervix is indicative of stage IVB disease. Despite the heterogeneity of anatomical sites that tumor may affect, stage IVB encompasses all distant metastasis within the current cancer staging schematic. This study examined survival outcomes based on metastasis sites of cervical cancer metastasis. Methods: This retrospective observational cohort study utilized the National Cancer Institute’s Surveillance, Epidemiology, and End Result Program from 2010-2018. The study population included 1,772 women with stage IVB cervical cancer who had cervical cancer metastasis to one or more of the following four organs: bone, brain, liver, or lung. Overall survival was assessed based on the metastatic extent in multivariable analysis. Results: The most common metastatic site was lung (n=1210, 68.3%) followed by bone (n=623,35.2%), liver (n=531, 30.0%), and brain (n=21, 1.2%). Multiple organ metastases were seen in 470 (26.5%) women with liver/lung metastases being the most frequent pattern (n=170, 9.6%), followed by bone/lung (n=166, 9.4%) and bone/liver (n=113, 6.4%). A total of 1,442 (81.4%) deaths occurred during the follow-up period. The cohort-level median overall survival was seven months, ranging from three months in all four organ metastases to 11 months in bone metastasis alone when stratified (absolute difference eight months, p<0.001). In multivariable analysis, multiple organ metastases were independently associated with 50% increased all-cause mortality risk compared to single organ metastasis (adjusted HR: 1.50, 95% CI: 1.33-1.69). Conclusions: Survival outcomes in those with stage IVB cervical cancer can vary based upon the extent of metastasis. Incorporating single versus multiple distant organ metastasis into the cancer staging schema may be useful (IVB1 vs IVB2). Objectives: In patients with cervical cancer, evidence of tumor spread to organs distant from the uterine cervix is indicative of stage IVB disease. Despite the heterogeneity of anatomical sites that tumor may affect, stage IVB encompasses all distant metastasis within the current cancer staging schematic. This study examined survival outcomes based on metastasis sites of cervical cancer metastasis. Methods: This retrospective observational cohort study utilized the National Cancer Institute’s Surveillance, Epidemiology, and End Result Program from 2010-2018. The study population included 1,772 women with stage IVB cervical cancer who had cervical cancer metastasis to one or more of the following four organs: bone, brain, liver, or lung. Overall survival was assessed based on the metastatic extent in multivariable analysis. Results: The most common metastatic site was lung (n=1210, 68.3%) followed by bone (n=623,35.2%), liver (n=531, 30.0%), and brain (n=21, 1.2%). Multiple organ metastases were seen in 470 (26.5%) women with liver/lung metastases being the most frequent pattern (n=170, 9.6%), followed by bone/lung (n=166, 9.4%) and bone/liver (n=113, 6.4%). A total of 1,442 (81.4%) deaths occurred during the follow-up period. The cohort-level median overall survival was seven months, ranging from three months in all four organ metastases to 11 months in bone metastasis alone when stratified (absolute difference eight months, p<0.001). In multivariable analysis, multiple organ metastases were independently associated with 50% increased all-cause mortality risk compared to single organ metastasis (adjusted HR: 1.50, 95% CI: 1.33-1.69). Conclusions: Survival outcomes in those with stage IVB cervical cancer can vary based upon the extent of metastasis. Incorporating single versus multiple distant organ metastasis into the cancer staging schema may be useful (IVB1 vs IVB2).