Beyond Sedlis—A novel histology-specific nomogram for predicting cervical cancer recurrence risk: An NRG/GOG ancillary analysis
| Autor: | Aaron H. Wolfson, Omar Ragab, Anne F. Rositch, Amanda Nickles Fader, David Miller, Warner K. Huh, Steven E. Waggoner, Kimberly Levinson, Nicola M. Spirtos, Laura L. Holman, Leah McNally, Saketh R. Guntupalli, Yi-Chun Lee, Krishnansu S. Tewari, Yovanni Casablanca, Kelly Jeanes Wilkinson, Anna Beavis, Michael Kelly, Linda Van Le, Akila N. Viswanathan, Christopher Purdy |
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| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Oncology medicine.medical_specialty medicine.medical_treatment Uterine Cervical Neoplasms Article 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Adjuvant therapy Humans Cervix Cervical cancer Proportional hazards model business.industry Obstetrics and Gynecology Histology Nomogram medicine.disease 030104 developmental biology medicine.anatomical_structure 030220 oncology & carcinogenesis Adenocarcinoma Female business Adjuvant |
| Zdroj: | Gynecol Oncol |
| ISSN: | 0090-8258 |
| Popis: | Purpose The Sedlis criteria define risk factors for recurrence warranting post-hysterectomy radiation for early-stage cervical cancer; however, these factors were defined for squamous cell carcinoma (SCC) at an estimated recurrence risk of ≥30%. Our study evaluates and compares risk factors for recurrence for cervical SCC compared with adenocarcinoma (AC) and develops histology-specific nomograms to estimate risk of recurrence and guide adjuvant treatment. Methods We performed an ancillary analysis of GOG 49, 92, and 141, and included stage I patients who were surgically managed and received no neoadjuvant/adjuvant therapy. Multivariable Cox proportional hazards models were used to evaluate independent risk factors for recurrence by histology and to generate prognostic histology-specific nomograms for 3-year recurrence risk. Results We identified 715 patients with SCC and 105 with AC; 20% with SCC and 17% with AC recurred. For SCC, lymphvascular space invasion (LVSI: HR 1.58, CI 1.12–2.22), tumor size (TS ≥4 cm: HR 2.67, CI 1.67–4.29), and depth of invasion (DOI; middle 1/3, HR 4.31, CI 1.81–10.26; deep 1/3, HR 7.05, CI 2.99–16.64) were associated with recurrence. For AC, only TS ≥4 cm, was associated with recurrence (HR 4.69, CI 1.25–17.63). For both histologies, there was an interaction effect between TS and LVSI. For those with SCC, DOI was most associated with recurrence (16% risk); for AC, TS conferred a 15% risk with negative LVSI versus a 25% risk with positive LVSI. Conclusions Current treatment standards are based on the Sedlis criteria, specifically derived from data on SCC. However, risk factors for recurrence differ for squamous cell and adenocarcinoma of the cervix. Histology-specific nomograms accurately and linearly represent risk of recurrence for both SCC and AC tumors and may provide a more contemporary and tailored tool for clinicians to base adjuvant treatment recommendations to their patients with cervical cancer. |
| Databáze: | OpenAIRE |
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