BACKGROUND: Up to 26% of patients with early-stage cervical cancer experience relapse after primary surgery. However, little is known about which factors influence prognosis following disease recurrence. Therefore, our aims were to determine post-recurrence disease-specific survival (PR-DSS) and to identify respective prognostic factors for PR-DSS. METHODS: Data from 528 patients with early-stage cervical cancer who relapsed after primary surgery performed between 2007 and 2016 were obtained from the SCANN study (Surveillance in Cervical CANcer). Factors related to the primary disease and recurrence were combined in a multivariable Cox proportional hazards model to predict PR-DSS. RESULTS: The 5-year PR-DSS was 39.1% (95% confidence interval [CI] 22.7%-44.5%), median disease-free interval between primary surgery and recurrence (DFI1) was 1.5 years, and median survival after recurrence was 2.5 years. Six significant variables were identified in the multivariable analysis and were used to construct the prognostic model. Two were related to primary treatment (largest tumour size and lymphovascular space invasion) and four to recurrence (DFI1, age at recurrence, presence of symptoms, and recurrence type). The C-statistic after 10-fold cross-validation of prognostic model reached 0.701 (95% CI 0.675-0.727). Three risk-groups with significantly differing prognoses were identified, with 5-year PR-DSS rates of 81.8%, 44.6%, and 12.7%. CONCLUSIONS: We developed the robust model of PR-DSS to stratify patients with relapsed cervical cancer according to risk profiles using six routinely recorded prognostic markers. The model can be utilised in clinical practice to aid decision-making on the strategy of recurrence management, and to better inform the patients.

Amsterdam University Medical Centers Center for Gynaecologic Oncology Amsterdam 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

Zobrazit více v PubMed

Wu ES, Jeronimo J, Feldman S. Barriers and Challenges to Treatment Alternatives for Early-Stage Cervical Cancer in Lower-Resource Settings. Journal of global oncology. 2017;3:572–82. PubMed PMC

Elit L, Fyles AW, Devries MC, Oliver TK, Fung-Kee-Fung M, Gynecology Cancer Disease Site G. Follow-up for women after treatment for cervical cancer: a systematic review. Gynecologic oncology. 2009;114:528–35. PubMed

Salani R, Khanna N, Frimer M, Bristow RE, Chen LM. An update on post-treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology (SGO) recommendations. Gynecologic oncology. 2017;146:3–10. PubMed

Cibula D, Potter R, Planchamp F, Avall-Lundqvist E, Fischerova D, Haie-Meder C, et al. The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the Management of Patients with Cervical Cancer. Virchows Archiv : an international journal of pathology. 2018;472:919–36. PubMed

Taarnhoj GA, Christensen IJ, Lajer H, Fuglsang K, Jeppesen MM, Kahr HS, et al. Risk of recurrence, prognosis, and follow-up for Danish women with cervical cancer in 2005–2013: A national cohort study. Cancer. 2018;124:943–51. PubMed

Qiu J-T, Abdullah NA, Chou H-H, Lin C-T, Jung S-M, Wang C-C, et al. Outcomes and prognosis of patients with recurrent cervical cancer after radical hysterectomy. Gynecologic oncology. 2012;127:472–7. PubMed

Seebacher V, Sturdza A, Bergmeister B, Polterauer S, Grimm C, Reinthaller A, et al. Factors associated with post-relapse survival in patients with recurrent cervical cancer: the value of the inflammation-based Glasgow Prognostic Score. Arch Gynecol Obstet. 2019;299:1055–62. PubMed PMC

Yoshida K, Kajiyama H, Utsumi F, Niimi K, Sakata J, Suzuki S, et al. A post-recurrence survival-predicting indicator for cervical cancer from the analysis of 165 patients who developed recurrence. Mol Clin Oncol. 2018;8:281–5. PubMed PMC

Gulseren V, Kocaer M, Gungorduk O, Ozdemir IA, Golbasi C, Budak A, et al. Isolated pulmonary metastases in patients with cervical cancer and the factors affecting survival after recurrence. Ginekologia polska. 2018;89:593–8. PubMed

Xie G, Wang R, Shang L, Qi C, Yang L, Huang L, et al. Calculating the overall survival probability in patients with cervical cancer: a nomogram and decision curve analysis-based study. BMC Cancer. 2020;20:833. PubMed PMC

Polterauer S, Grimm C, Hofstetter G, Concin N, Natter C, Sturdza A, et al. Nomogram prediction for overall survival of patients diagnosed with cervical cancer. Br J Cancer. 2012;107:918–24. PubMed PMC

Shim SH, Lee SW, Park JY, Kim YS, Kim DY, Kim JH, et al. Risk assessment model for overall survival in patients with locally advanced cervical cancer treated with definitive concurrent chemoradiotherapy. Gynecol Oncol. 2013;128:54–9. PubMed

Tseng JY, Yen MS, Twu NF, Lai CR, Horng HC, Tseng CC, et al. Prognostic nomogram for overall survival in stage IIB-IVA cervical cancer patients treated with concurrent chemoradiotherapy. Am J Obstet Gynecol. 2010;202:174 e1–7. PubMed

Qiu JT, Abdullah NA, Chou HH, Lin CT, Jung SM, Wang CC, et al. Outcomes and prognosis of patients with recurrent cervical cancer after radical hysterectomy. Gynecol Oncol. 2012;127:472–7. PubMed

Querleu D, Cibula D, Abu-Rustum NR. 2017 Update on the Querleu-Morrow Classification of Radical Hysterectomy. Annals of surgical oncology. 2017;24:3406–12. PubMed PMC

Cibula D, Dostalek L, Jarkovsky J, Mom CH, Lopez A, Falconer H, et al. The annual recurrence risk model for tailored surveillance strategy in patients with cervical cancer. European journal of cancer. 2021;158:111–22. PubMed PMC

Rose PG, Java JJ, Salani R, Geller MA, Secord AA, Tewari KS, et al. Nomogram for Predicting Individual Survival After Recurrence of Advanced-Stage, High-Grade Ovarian Carcinoma. Obstetrics & Gynecology. 2019;133. PubMed PMC

Chan JK, Tian C, Teoh D, Monk BJ, Herzog T, Kapp DS, et al. Survival after recurrence in early-stage high-risk epithelial ovarian cancer: a Gynecologic Oncology Group study. Gynecologic oncology. 2010;116:307–11. PubMed

Elit L, Kennedy EB, Fyles A, Metser U. Follow-up for cervical cancer: a Program in Evidence-Based Care systematic review and clinical practice guideline update. Curr Oncol. 2016;23:109–18. PubMed PMC

Lajtman E, Mlyncek M, Matejka M, Kapusta T. Quality of Life after Endometrial Cancer Surgery with and without Lymphadenectomy: A Single Institution Retrospective Cohort Study. International Journal of Gynecological Cancer. 2017;27:571-.

Zola P, Fuso L, Mazzola S, Piovano E, Perotto S, Gadducci A, et al. Could follow-up different modalities play a role in asymptomatic cervical cancer relapses diagnosis? An Italian multicenter retrospective analysis. Gynecologic oncology. 2007;107:S150–4. PubMed

Peters PN, Pierson WE, Chen LM, Westphalen AC, Chapman JS, Hsu IC. PET-detected asymptomatic recurrence is associated with improved survival in recurrent cervical cancer. Abdom Radiol (NY). 2020. PubMed

Hillesheim I, Limone GA, Klimann L, Monego H, Appel M, de Souza A, et al. Cervical Cancer Posttreatment Follow-up: Critical Analysis. Int J Gynecol Cancer. 2017;27:1747–52. PubMed

Survival associated with extent of radical hysterectomy in early-stage cervical cancer: a subanalysis of the Surveillance in Cervical CANcer (SCCAN) collaborative study

Association of Hospital Surgical Volume With Survival in Early-Stage Cervical Cancer Treated With Radical Hysterectomy