Risk factors for pelvic and distant recurrence in locally advanced cervical cancer

Autor: Vanessa A. Fabri, Michael Jenwel Chen, João Paulo da Nogueira Silveira Lima, Solange Moraes Sanches, Glauco Baiocchi, Ana Carolina Matos Queiroz, Henrique Mantoan, Alexandre Andre Balieiro Anastacio da Costa, Andréia P. Guimarães, Adriana Regina Gonçalves Ribeiro
Rok vydání: 2018
Předmět:
Oncology
Adult
medicine.medical_specialty
medicine.medical_treatment
Uterine Cervical Neoplasms
Antineoplastic Agents
Disease-Free Survival
Pelvis
03 medical and health sciences
Young Adult
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Humans
030212 general & internal medicine
Aged
Neoplasm Staging
Pelvic Neoplasms
Proportional Hazards Models
Retrospective Studies
Cervical cancer
Aged
80 and over
Univariate analysis
030219 obstetrics & reproductive medicine
Proportional hazards model
business.industry
Hazard ratio
Obstetrics and Gynecology
Consolidation Chemotherapy
Chemoradiotherapy
Middle Aged
medicine.disease
Prognosis
Combined Modality Therapy
Radiation therapy
Treatment Outcome
Reproductive Medicine
Concomitant
Cohort
Multivariate Analysis
Female
Cisplatin
Neoplasm Recurrence
Local
business
Zdroj: European journal of obstetrics, gynecology, and reproductive biology. 235
ISSN: 1872-7654
Popis: Objective Despite the benefits of concomitant radiotherapy and cisplatin for locally advanced cervical cancer, recurrence rates remain high. New treatment strategies such as consolidation chemotherapy and different concomitant chemotherapy combinations have been tested in recent years. Identification of the best candidates for each treatment strategy could optimize results. Study design A retrospective review of data from 127 patients with locally advanced cervical cancer (International Federation of Gynecology and Obstetrics Stages IIB–IVA), treated at a single institution from 2005 to 2014. Risk factors for loco-regional and systemic recurrence, and prognostic factors for overall survival (OS) were analysed using Cox regression. Survival of patients treated with consolidation chemotherapy was compared with survival of patients not treated with consolidation chemotherapy in the role cohort and in a propensity-score-matched cohort. Results With a median follow-up time of 48.7 months, loco-regional-recurrence-free survival (LRFS), distant-metastasis-free survival (DMFS) and OS at 5 years were 76.6%, 54.0% and 63.0%, respectively. On multivariate analysis, tumour size ≥6 cm was associated with shorter LRFS [hazard ratio (HR) 5.18; 95% confidence interval (CI) 1.45–18.45; p = 0.011], and adenocarcinoma (HR 2.48; 95% CI 1.10–5.57; p = 0.028) and positive lymph nodes (HR 2.21; 95% CI 1.303–4.72; p = 0.041) were associated with shorter DMFS. Tumour size ≥6 cm was associated with shorter OS (HR 2.64; 95% CI 1.09–6.35; p = 0.031). Twenty-two patients were treated with consolidation chemotherapy; on univariate analysis, these patients had longer OS compared with patients who were not treated with consolidation chemotherapy (p = 0.043). In a propensity-score-matched cohort, patients treated with consolidation chemotherapy had longer DMFS and OS compared with patients who were not treated with consolidation chemotherapy, although the difference was not significant. Conclusions Different risk factors are associated with loco-regional and distant metastases in patients with locally advanced cervical cancer, and could potentially lead to particular therapeutic strategies. Although the number of patients treated with consolidation chemotherapy in the study cohort was small, they seemed to live longer and to have better control of distant relapse then patients who were not treated with consolidation chemotherapy.
Databáze: OpenAIRE
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