PURPOSE: Current guidelines for surveillance strategy in cervical cancer are rigid, recommending the same strategy for all survivors. The aim of this study was to develop a robust model allowing for individualised surveillance based on a patient's risk profile. METHODS: Data of 4343 early-stage patients with cervical cancer treated between 2007 and 2016 were obtained from the international SCCAN (Surveillance in Cervical Cancer) consortium. The Cox proportional hazards model predicting disease-free survival (DFS) was developed and internally validated. The risk score, derived from regression coefficients of the model, stratified the cohort into significantly distinctive risk groups. On its basis, the annual recurrence risk model (ARRM) was calculated. RESULTS: Five variables were included in the prognostic model: maximal pathologic tumour diameter; tumour histotype; grade; number of positive pelvic lymph nodes; and lymphovascular space invasion. Five risk groups significantly differing in prognosis were identified with a five-year DFS of 97.5%, 94.7%, 85.2% and 63.3% in increasing risk groups, whereas a two-year DFS in the highest risk group equalled 15.4%. Based on the ARRM, the annual recurrence risk in the lowest risk group was below 1% since the beginning of follow-up and declined below 1% at years three, four and >5 in the medium-risk groups. In the whole cohort, 26% of recurrences appeared at the first year of the follow-up, 48% by year two and 78% by year five. CONCLUSION: The ARRM represents a potent tool for tailoring the surveillance strategy in early-stage patients with cervical cancer based on the patient's risk status and respective annual recurrence risk. It can easily be used in routine clinical settings internationally.

Amsterdam Medical Center Amsterdam the Netherlands

Baskent University School of Medicine Department of Gynecology and Obstetrics Division of Gynecologic Oncology Ankara Turkey

Department of Gynaecology and Obstetrics University Hospital Pilsen Charles University Prague Czech Republic

Department of Gynecologic Oncology and Reproductive Medicine The University of Texas MD Anderson Cancer Center Houston TX 77030 USA

Department of Gynecologic Oncology Hospital Italiano de Buenos Aires Instituto Universitario Hospital Italiano Buenos Aires Argentina

Department of Gynecologic Oncology Instituto Nacional de Cancerología Bogotá Colombia

Department of Gynecologic Oncology Zekai Tahir Burak Women's Health and Research Hospital University of Health Sciences Ankara Turkey

Department of Gynecological Surgery National Institute of Neoplastic Diseases Lima Peru

Department of Obstetrics and Gynecology Faculty of Medicine University Hospital and University of Ostrava Ostrava Czech Republic

Department of Pelvic Cancer Karolinska University Hospital and Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden

Fondazione Policlinico Universitario A Gemelli IRCCS UOC Ginecologia Oncologica Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica Rome Italy

Gynecologic Oncology Center Department of Obstetrics and Gynecology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Gynecologic Oncology Unit La Paz University Hospital IdiPAZ Madrid Spain

Gynecology Medical University of Graz Graz Austria

Gynecology Oncology Center National Institute of Cancerology Mexico Mexico

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic

Memorial Sloan Kettering Cancer Center USA

Queensland Centre for Gynaecological Cancer The University of Queensland Australia

University Hospital Brno Medical Faculty of Masaryk University Czech Republic

University of Milano Bicocca Department of Obstetrics and Gynecology Gynaecologic Oncology Surgical Unit ASST Monza San Gerardo Hospital Monza Italy

Wolfson Institute of Preventive Medicine Barts Cancer Centre Queen Mary University of London and Barts Health NHS Trust London UK

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