Clinical implication of surgically treated early-stage cervical cancer with multiple high-risk factors

Journal of Gynecologic Oncology 2015³â 26±Ç 1È£ p.3 ~ p.11

(Matsuo Koji) - University of Southern California Los Angeles County Medical Center Department of Obstetrics and Gynecology
(Mabuchi Seiji) - Japan Osaka University Graduate School of Medicine Department of Obstetrics and Gynecology
(Okazawa Mika) - Osaka Medical Center for Cancer and Cardiovascular Diseases Department of Gynecology
(Kawano Mahiru) - Osaka University Graduate School of Medicine Department of Obstetrics and Gynecology
(Kuroda Hiromasa) - Osaka University Graduate School of Medicine Department of Obstetrics and Gynecology
(Kamiura Shoji) - Osaka Medical Center for Cancer and Cardiovascular Diseases Department of Gynecology

Abstract

Objective: Presence of high-risk factor in cervical cancer is known to be associated with decreased survival outcomes. However, the significance of multiple high-risk factors in early-stage cervical cancer related to survival outcomes, recurrence patterns, and treatment implications is not well elucidated.

Methods: A retrospective study was conducted for surgically treated cervical cancer patients (stage IA2-IIB, n=540). Surgical-pathological risk factors were examined and tumors expressing ¡Ã1 high-risk factors (nodal metastasis, parametrial involvement, or positive surgical margin) were eligible for analysis (n=177, 32.8%). Survival analysis was performed based on the number of high-risk factors and the type of adjuvant therapy.

Results: There were 68 cases (38.4%) expressed multiple high-risk factors (2 high-risk factors: n=58, 32.8%; 3 high-risk factors: n=10, 5.6%). Multiple high-risk factors remained an independent prognosticator for decreased survival outcomes after controlling for age, histology, stage, and treatment type (disease-free survival: hazard ratio [HR], 2.34; p=0.002; overall survival: HR, 2.32; p=0.007). Postoperatively, 101 cases (57.1%) received concurrent chemoradiotherapy (CCRT) and 76 cases (42.9%) received radiotherapy (RT) alone. CCRT was beneficial in single high-risk factor cases: HRs for CCRT over RT alone for cumulative risk of locoregional and distant recurrence, 0.27 (p=0.022) and 0.27 (p=0.005), respectively. However, tumor expressing multiple high-risk factors completely offset the benefit of CCRT over RT alone for the risk of distant recurrence: HR for locoregional and distant recurrence, 0.31 (p=0.071) and 0.99 (p=0.980), respectively.

Conclusion: Special consideration for the significance of multiple high-risk factors merits further investigation in the management of surgically treated early-stage cervical cancer.

Å°¿öµå

Combined Modality Therapy, Neoplasm Recurrence, Local, Retrospective Studies, Risk Factors, Survival Analysis, Uterine Cervical Neoplasms
¿ø¹® ¹× ¸µÅ©¾Æ¿ô Á¤º¸
µîÀçÀú³Î Á¤º¸
SCI(E) MEDLINE ÇмúÁøÈïÀç´Ü(KCI) KoreaMed ´ëÇÑÀÇÇÐȸ ȸ¿ø 
ÁÖÁ¦ÄÚµå
ÁÖÁ¦¸í(Target field)
¿¬±¸´ë»ó(Population)
¿¬±¸Âü¿©(Sample size)
´ë»ó¼ºº°(Gender)
Áúº´Æ¯¼º(Condition Category)
¿¬±¸È¯°æ(Setting)
¿¬±¸¼³°è(Study Design)
¿¬±¸±â°£(Period)
ÁßÀç¹æ¹ý(Intervention Type)
ÁßÀç¸íĪ(Intervention Name)
Å°¿öµå(Keyword)
À¯È¿¼º°á°ú(Recomendation)
Multiple high-risk factors remained an independent prognosticator for decreased survival outcomes; Tumor expressing multiple high-risk factors completely offset the benefit of CCRT over RT alone for the risk of distant recurrence: HR for locoregional and distant recurrence, 0.31 (p=0.071) and 0.99 (p=0.980), respectively.
¿¬±¸ºñÁö¿ø(Fund Source)
±Ù°Å¼öÁØÆò°¡(Evidence Hierarchy)
ÃâÆdz⵵(Year)
Âü¿©ÀúÀÚ¼ö(Authors)
´ëÇ¥ÀúÀÚ
KCDÄÚµå
ICD 03
°Ç°­º¸ÇèÄÚµå