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Role of adjuvant therapy in intermediate-risk cervical cancer patients - Subanalyses of the SCCAN study
Authors | |
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Year of publication | 2023 |
Type | Article in Periodical |
Magazine / Source | Gynecologic oncology |
MU Faculty or unit | |
Citation | |
Web | https://www.sciencedirect.com/science/article/pii/S0090825823000148?via%3Dihub |
Doi | http://dx.doi.org/10.1016/j.ygyno.2023.01.014 |
Keywords | Cervical cancer; Intermediate risk; GOG criteria; Radial surgery; Adjuvant treatment; Radiotherapy |
Description | Objective. The "intermediate-risk" (IR) group of early-stage cervical cancer patients is characterized by nega-tive pelvic lymph nodes and a combination of tumor-related prognostic risk factors such as tumor size >= 2 cm, lymphovascular space invasion (LVSI), and deep stromal invasion. However, the role of adjuvant treatment in these patients remains controversial. We investigated whether adjuvant (chemo)radiation is associated with a survival benefit after radical surgery in patients with IR cervical cancer. Methods. We analyzed data from patients with IR cervical cancer (tumor size 2-4 cm plus LVSI OR tumor size >4 cm; N0; no parametrial invasion; clear surgical margins) who underwent primary curative-intent surgery between 2007 and 2016 and were retrospectively registered in the international multicenter Surveillance in Cervical CANcer (SCCAN) study. Results. Of 692 analyzed patients, 274 (39.6%) received no adjuvant treatment (AT-) and 418 (60.4%) re-ceived radiotherapy or chemoradiotherapy (AT+). The 5-year disease-free survival (83.2% and 80.3%; PDFS = 0.365) and overall survival (88.7% and 89.0%; POS = 0.281) were not significantly different between the AT- and AT+ groups, respectively. Adjuvant (chemo)radiotherapy was not associated with a survival benefit after adjusting for confounding factors by case-control propensity score matching or in subgroup analyses of patients with tumor size >= 4 cm and <4 cm. In univariable analysis, adjuvant (chemo)radiotherapy was not identified as a prognostic factor in any of the subgroups (full cohort: PDFS = 0.365; POS = 0.282). Conclusion. Among patients with IR early-stage cervical cancer, radical surgery alone achieved equal disease -free and overall survival rates to those achieved by combining radical surgery with adjuvant (chemo)radiotherapy. (c) 2023 Elsevier Inc. All rights reserved. |