Abstract
PurposeTo investigate the recurrence patterns and prognostic factors of patients with recurrent cervical cancer after radical hysterectomy with node dissection (RHND) followed by adjuvant radiotherapy (RT)/concurrent chemoradiotherapy (CCRT).MethodsThe medical records of 153 patients with pre-operative International Federation of Gynecology and Obstetrics stage IB-IIA cervical cancer, who were treated with RHND followed by adjuvant RT/CCRT at the Liaoning Cancer Hospital between January 1, 2012 and May 31, 2018, were retrospectively analyzed.ResultsThe median disease progression-free survival time was 16 months, and 75.2% (115/153) of patients had a relapse within two years. The survival of patients with multi-site relapse was significantly lower in comparison to those with relapse in a single site (p < 0.001). The survival rate of patients with distant metastasis (DM) and combined recurrence (DM with localregional recurrence [LR]) was significantly lower than that of patients with only LR (p = 0.006, p < 0.001). Furthermore, the survival rate of patients with combined recurrence was significantly lower than that of patients with only DM (p = 0.046). Multivariate analysis showed that resection margin involvement, para-aortic and common iliac lymph node metastasis, DM, no treatment after disease relapse, and early disease relapse were independent prognostic factors associated with poor survival.ConclusionMost of the cervical cancer patients who received initial RHND followed by adjuvant RT/CCRT had a relapse within two years. Resection margin involvement, para-aortic and common iliac lymph node metastasis, DM, no treatment after recurrence, and early disease relapse were found to be prognostic factors in patients with recurrent cervical cancer after RHND followed by adjuvant RT/CCRT.
Highlights
Cytological screening has substantially reduced the incidence rate and mortality rate of cervical cancer, but cervical cancer is still the fourth most common malignancy in women [1, 2]
The results showed that the risk factors of death after disease relapse were positive resection margin, positive common iliac lymph node, positive para-aortic lymph node, different metastatic sites, no treatment after recurrence, and early disease recurrence
This study found that a positive common iliac lymph node was an independent risk factor for poor prognosis in recurrent cervical cancer patients, while other sites of pelvic lymph node metastasis are not
Summary
Cytological screening has substantially reduced the incidence rate and mortality rate of cervical cancer, but cervical cancer is still the fourth most common malignancy in women [1, 2]. Postoperative adjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) is recommended, depending on the risk factors as evaluated in postoperative histopathological examinations [3, 4]. Intermediate-risk factors include large tumor size, lymphovascular space invasion (LVSI), and deep cervical interstitial infiltration [5, 6]. High-risk factors include lymph node metastasis, parametrial invasion, and resection margin involvement [7, 8]. The existence of risk factors is associated with a higher recurrence rate and poor survival outcome in patients with early cervical cancer. These patients can benefit from postoperative RT or CCRT, which can prolong the disease progression-free survival (PFS) time and overall survival (OS) time [7]
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