Beyond Sedlis-A novel histology-specific nomogram for predicting cervical cancer recurrence risk: An NRG/GOG ancillary analysis

被引：52

作者：

Levinson, Kimberly ^{[1
]}

Beavis, Anna L. ^{[1
]}

Purdy, Christopher ^{[2
]}

Rositch, Anne F. ^{[3
]}

Viswanathan, Akila ^{[1
]}

Wolfson, Aaron H. ^{[4
]}

Kelly, Michael G. ^{[5
]}

Tewari, Krishnansu S. ^{[6
]}

McNally, Leah ^{[7
]}

Guntupalli, Saketh R. ^{[8
]}

Ragab, Omar ^{[9
]}

Lee, Yi-Chun ^{[10
]}

Miller, David S. ^{[11
]}

Huh, Warner K. ^{[12
]}

Wilkinson, Kelly J. ^{[13
]}

Spirtos, Nicola M. ^{[14
]}

Van Le, Linda ^{[15
]}

Casablanca, Yovanni ^{[16
]}

Holman, Laura L. ^{[17
]}

Waggoner, Steven E. ^{[18
]}

Fader, Amanda N. ^{[1
]}

机构：

[1] Johns Hopkins Univ, Sch Med, Baltimore, MD USA

[2] Roswell Pk Comprehens Canc Ctr, Biostatistio & Bioinformat, Clin Trial Dev Div, NRG Oncol, Buffalo, NY USA

[3] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Baltimore, MD USA

[4] Sylvester Comprehens Canc Ctr, Miami, FL USA

[5] Wake Forest Baptist Med Ctr, Winston Salem, NC USA

[6] Univ Calif Irvine, Orange, CA 92668 USA

[7] Duke Canc Inst, Durham, NC USA

[8] Univ Colorado Anschutz, Aurora, CO USA

[9] USC, Keck Sch Med, Los Angeles, CA USA

[10] SUNY Hlth Sci Ctr Brooklyn, Brooklyn, NY USA

[11] Univ Texas Southwestern Med Ctr Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390 USA

[12] Univ Alabama Birmingham, Birmingham, AL USA

[13] Univ Mississippi, Med Ctr, Jackson, MS 39216 USA

[14] Womens Canc Ctr, Las Vegas, NV USA

[15] Univ N Carolina, Sch Med, Chapel Hill, NC 27515 USA

[16] Walter Reed Natl Med Ctr, Bethesda, MD USA

[17] Univ Oklahoma, Hlth Sci Ctr, Stephenson Canc Ctr, 800 Northeast Tenth St, Oklahoma City, OK USA

[18] Case Western Reserve Univ, Cleveland, OH 44106 USA

来源：

GYNECOLOGIC ONCOLOGY | 2021年 / 162卷 / 03期

关键词：

Cervical cancer; Adenocarcinoma; Stage I; Adjuvant radiation; SQUAMOUS-CELL CARCINOMA; STAGE IB; ADENOSQUAMOUS CARCINOMAS; RADICAL HYSTERECTOMY; RANDOMIZED-TRIAL; UTERINE CERVIX; ADENOCARCINOMA; LYMPHADENECTOMY;

D O I：

10.1016/j.ygyno.2021.06.017

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

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 histol-ogies, there was an interaction effect between TS and LVSI. For those with SCC, DOI was most associated with re-currence (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. (c) 2021 Elsevier Inc. All rights reserved.

引用

页码：532 / 538

页数：7

共 18 条

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