Surgery of primary sites for stage IVB cervical cancer patients receiving chemoradiotherapy: a population-based study

다국어 초록 (Multilingual Abstract)

Objective: The purpose of this study was to analyze the impact of surgery of primary sites on stage IVB cervical cancer patients from a population-based database, the Surveillance, Epidemiology and End Results (SEER).
Methods: Propensity score matching was performed to minimize heterogeneity in patient between with-surgery group and without-surgery group. Clinicopathological characteristics were compared using the χ2 or Fisher's exact test. Survival analysis included the Kaplan-Meier method, log-rank test, and Cox proportional hazards model.
Results: Between 2010-2015, a total of 1,139 International Federation of Gynecology and Obstetrics (FIGO) stage IVB cervical cancer patients receiving chemoradiotherapy (CRT) were included in this retrospective study. Within post-matching cohort, the median duration of overall survival (OS) in stage IVB cervical cancer patients receiving CRT was 22 months. The overall 5-year survival rate was 25.7%. The increasing American Joint Committee on Cancer T stage (T1 vs. T2, p=0.033, hazard ratio [HR]=1.79, 95% confidence interval [CI]=1.05–3.05; T1 vs. T3, p=0.003, HR=2.20, 95% CI=1.31–3.67; T1 vs. T4, p=0.037, HR=2.75, 95% CI=1.06–7.12) and visceral metastasis (with vs. without, p=0.038, HR=1.60, 95% CI=1.03–2.49) was reported as independent risk factors of OS. Surgery of primary sites combined with CRT tended to prolong the survival of stage IVB cervical cancer patients (p<0.001, HR=0.36, 95% CI=0.21–0.61) compared with CRT, especially for patients without visceral metastasis (p=0.005, HR=0.31, 95% CI=0.14–0.70).
Conclusions: In conclusion, patients with stage IVB cervical cancer may achieve their best outcomes through CRT combined with surgery of primary sites. However, it deserves large scale prospective clinical trials to confirm.

참고문헌 (Reference)

1 김기동, "The type of metastasis is a prognostic factor in disseminated cervical cancer" 대한부인종양학회 21 (21): 186-190, 2010

2 Green JA, "Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix : a systematic review and meta-analysis" 358 : 781-786, 2001

3 Classe JM, "Surgery after concurrent chemoradiotherapy and brachytherapy for the treatment of advanced cervical cancer : morbidity and outcome : results of a multicenter study of the GCCLCC(Groupe des Chirurgiens de Centre de Lutte Contre le Cancer)" 102 : 523-529, 2006

4 Pecorelli S, "Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium" 105 : 103-104, 2009

5 Morice P, "Results of the GYNECO 02 study, an FNCLCC phase III trial comparing hysterectomy with no hysterectomy in patients with a(clinical and radiological)complete response after chemoradiation therapy for stage IB2 or II cervical cancer" 17 : 64-71, 2012

6 Fagotti A, "Radical surgery in advanced cervical cancer patients receiving bevacizumab-containing chemotherapy : a"Real Life Experience"" 28 : 1569-1575, 2018

7 Keys HM, "Radiation therapy with and without extrafascial hysterectomy for bulky stage IB cervical carcinoma : a randomized trial of the Gynecologic Oncology Group" 89 : 343-353, 2003

8 Nishio S, "Race and nodal disease status are prognostic factors in patients with stage IVB cervical cancer" 9 : 32321-32330, 2018

9 Oishi S, "Prognostic factors and treatment outcome for patients with stage IVB cervical cancer" 36 : 3471-3475, 2016

10 Ferrandina G, "Preoperative concomitant chemoradiotherapy in locally advanced cervical cancer : safety, outcome, and prognostic measures" 107 : S127-32, 2007

11 Sasano T, "Predictors of survival in patients with FIGO stage IVB cervical cancer" 26 : 528-533, 2016

12 Mazeron R, "Post radiation hysterectomy in locally advanced cervical cancer : outcomes and dosimetric impact" 120 : 460-466, 2016

13 Jurado M, "Pilot study of concurrent cisplatin, 5-fluorouracil, and external beam radiotherapy prior to radical surgery +/-intraoperative electron beam radiotherapy in locally advanced cervical cancer" 74 : 30-37, 1999

14 Zighelboim I, "Outcomes in 24 selected patients with stage IVB cervical cancer and excellent performance status treated with radiotherapy and chemotherapy" 24 : 625-630, 2006

15 Hwang JH, "Outcomes and toxicities for the treatment of stage IVB cervical cancer" 285 : 1685-1693, 2012

16 Ittiamornlert P, "Neutrophil-lymphocyte ratio as a predictor of oncologic outcomes in stage IVB, persistent, or recurrent cervical cancer patients treated by chemotherapy" 19 : 51-, 2019

17 Houvenaeghel G, "Long-term survival after concomitant chemoradiotherapy prior to surgery in advanced cervical carcinoma" 100 : 338-343, 2006

18 Vandecasteele K, "Intensity-modulated arc therapy with cisplatin as neo-adjuvant treatment for primary irresectable cervical cancer. Toxicity, tumour response and outcome" 188 : 576-581, 2012

19 심승혁, "Impact of adjuvant hysterectomy on prognosis in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy: a meta-analysis" 대한부인종양학회 29 (29): 1-18, 2018

20 김희승, "Impact of Chemoradiation on Prognosis in Stage IVB Cervical Cancer with Distant Lymphatic Metastasis" 대한암학회 45 (45): 193-201, 2013

21 Iqbal J, "Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States" 313 : 165-173, 2015

22 Kim JY, "Curative chemoradiotherapy in patients with stage IVB cervical cancer presenting with paraortic and left supraclavicular lymph node metastases" 84 : 741-747, 2012

23 Tummers P, "Completion surgery after intensity-modulated arc therapy in the treatment of locally advanced cervical cancer : feasibility, surgical outcome, and oncologic results" 23 : 877-883, 2013

24 Ferrandina G, "Completion surgery after concomitant chemoradiation in locally advanced cervical cancer : a comprehensive analysis of pattern of postoperative complications" 21 : 1692-1699, 2014

25 Omura GA, "Chemotherapy for stage IVB or recurrent cancer of the uterine cervix" 123 (123): 1996

26 Ferrandina G, "Chemoradiation with concomitant boosts followed by radical surgery in locally advanced cervical cancer : long-term results of the ROMA-2 prospective phase 2 study" 90 : 778-785, 2014

27 Chen W, "Cancer statistics in China, 2015" 66 : 115-132, 2016

28 Malcolm D. Mattes, "Breast Cancer Subtype as a Predictor of Lymph Node Metastasis according to the SEER Registry" 한국유방암학회 18 (18): 143-148, 2015

29 Nishio S, "Analysis of the clinicopathological prognosis of stage IVb cervical carcinoma" 19 : 497-503, 2008

30 Haoran Li, "Advances in diagnosis and treatment of metastatic cervical cancer" 대한부인종양학회 27 (27): 1-20, 2016

31 Lu H, "A prospective study on neoadjuvant chemoradiotherapy plus anti-EGFR monoclonal antibody followed by surgery for locally advanced cervical cancer" 11 : 3785-3792, 2018