Role of adjuvant therapy in intermediate-risk cervical cancer patients – Subanalyses of the SCCAN study

David Cibula; Huseyin Akilli; Jiri Jarkovsky; Luc van Lonkhuijzen; Giovanni Scambia; Mehmet Mutlu Meydanli; David Isla Ortiz; Henrik Falconer; Nadeem R. Abu-Rustum; Diego Odetto; Jaroslav Klát; Ricardo dos Reis; Ignacio Zapardiel; Giampaolo di Martino; Jiri Presl; Rene Laky; Aldo López; Vit Weinberger; Andreas Obermair; Rene Pareja; Renata Poncová; Constantijne Mom; Nicolò Bizzarri; Martina Borčinová; Koray Aslan; Rosa Angélica Salcedo Hernandez; Guus Fons; Klára Benešová; Lukáš Dostálek; Ali Ayhan

doi:10.1016/j.ygyno.2023.01.014

Role of adjuvant therapy in intermediate-risk cervical cancer patients – Subanalyses of the SCCAN study

David Cibula^*
, Huseyin Akilli
, Jiri Jarkovsky
, Luc van Lonkhuijzen
, Giovanni Scambia
, Mehmet Mutlu Meydanli
, David Isla Ortiz
, Henrik Falconer
, Nadeem R. Abu-Rustum
, Diego Odetto
, Jaroslav Klát
, Ricardo dos Reis
, Ignacio Zapardiel
, Giampaolo di Martino
, Jiri Presl
, Rene Laky
, Aldo López
, Vit Weinberger
, Andreas Obermair
, Rene Pareja

Renata Poncová, Constantijne Mom, Nicolò Bizzarri, Martina Borčinová, Koray Aslan, Rosa Angélica Salcedo Hernandez, Guus Fons, Klára Benešová, Lukáš Dostálek, Ali Ayhan

^*Corresponding author for this work

Charles University
Baskent University
Masaryk University
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
University of Health Sciences
Gynecology Oncology Center, National Institute of Cancerology Mexico, Mexico
Karolinska Institutet
Memorial Sloan-Kettering Cancer Center
Hospital Italiano de Buenos Aires
University of Ostrava
Hospital de Câncer de Barretos
Universidad Autónoma de Madrid
University of Milan - Bicocca
Medical University of Graz
Instituto Nacional de Enfermedades Neoplásicas
University of Queensland
Instituto Nacional De Cancerologia, Bogotá, Colombia
Amsterdam UMC - University of Amsterdam
Amsterdam University Medical Centers
National Institute of Cancerology Mexico
Karolinska University Hospital
Instituto Nacional de Cancerología

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Objective: The “intermediate-risk” (IR) group of early-stage cervical cancer patients is characterized by negative 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%) received radiotherapy or chemoradiotherapy (AT+). The 5-year disease-free survival (83.2% and 80.3%; P_DFS = 0.365) and overall survival (88.7% and 89.0%; P_OS = 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: P_DFS = 0.365; P_OS = 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.

Original language	English
Pages (from-to)	195-202
Number of pages	8
Journal	Gynecologic oncology
Volume	170
DOIs	https://doi.org/10.1016/j.ygyno.2023.01.014
Publication status	Published - 1 Mar 2023

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Adjuvant treatment
Cervical cancer
GOG criteria
Intermediate risk
Radial surgery
Radiotherapy

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10.1016/j.ygyno.2023.01.014

Role-of-adjuvant-therapy-in-intermediate-risk-cervical-cancer-patients--subanalyses-of-the-sccan-study.pdfFinal published version, 1.23 MBLicence: Taverne

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Cibula, D., Akilli, H., Jarkovsky, J., van Lonkhuijzen, L., Scambia, G., Meydanli, M. M., Ortiz, D. I., Falconer, H., Abu-Rustum, N. R., Odetto, D., Klát, J., dos Reis, R., Zapardiel, I., di Martino, G., Presl, J., Laky, R., López, A., Weinberger, V., Obermair, A., ... Ayhan, A. (2023). Role of adjuvant therapy in intermediate-risk cervical cancer patients – Subanalyses of the SCCAN study. Gynecologic oncology, 170, 195-202. https://doi.org/10.1016/j.ygyno.2023.01.014

@article{a6d49050e0894b39b92dfef19ca8c8dc,

title = "Role of adjuvant therapy in intermediate-risk cervical cancer patients – Subanalyses of the SCCAN study",

abstract = "Objective: The “intermediate-risk” (IR) group of early-stage cervical cancer patients is characterized by negative 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\%) received 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.",

keywords = "Adjuvant treatment, Cervical cancer, GOG criteria, Intermediate risk, Radial surgery, Radiotherapy",

author = "David Cibula and Huseyin Akilli and Jiri Jarkovsky and \{van Lonkhuijzen\}, Luc and Giovanni Scambia and Meydanli, \{Mehmet Mutlu\} and Ortiz, \{David Isla\} and Henrik Falconer and Abu-Rustum, \{Nadeem R.\} and Diego Odetto and Jaroslav Kl{\'a}t and \{dos Reis\}, Ricardo and Ignacio Zapardiel and \{di Martino\}, Giampaolo and Jiri Presl and Rene Laky and Aldo L{\'o}pez and Vit Weinberger and Andreas Obermair and Rene Pareja and Renata Poncov{\'a} and Constantijne Mom and Nicol{\`o} Bizzarri and Martina Bor{\v c}inov{\'a} and Koray Aslan and \{Salcedo Hernandez\}, \{Rosa Ang{\'e}lica\} and Guus Fons and Kl{\'a}ra Bene{\v s}ov{\'a} and Luk{\'a}{\v s} Dost{\'a}lek and Ali Ayhan",

note = "Funding Information: This work was supported by grants from Charles University in Prague ( COOPERATIO , UNCE 204065 ), Ministry of Health of the Czech Republic ( MH CZ – DRO-VFN64165 ), and the Czech Health Research Council ( NV19-03-00023 ). The funding sources were not involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Publisher Copyright: {\textcopyright} 2023 Elsevier Inc.",

year = "2023",

month = mar,

day = "1",

doi = "10.1016/j.ygyno.2023.01.014",

language = "English",

volume = "170",

pages = "195--202",

journal = "Gynecologic oncology",

issn = "0090-8258",

publisher = "Academic Press Inc.",

}

Cibula, D, Akilli, H, Jarkovsky, J, van Lonkhuijzen, L, Scambia, G, Meydanli, MM, Ortiz, DI, Falconer, H, Abu-Rustum, NR, Odetto, D, Klát, J, dos Reis, R, Zapardiel, I, di Martino, G, Presl, J, Laky, R, López, A, Weinberger, V, Obermair, A, Pareja, R, Poncová, R, Mom, C, Bizzarri, N, Borčinová, M, Aslan, K, Salcedo Hernandez, RA, Fons, G, Benešová, K, Dostálek, L & Ayhan, A 2023, 'Role of adjuvant therapy in intermediate-risk cervical cancer patients – Subanalyses of the SCCAN study', Gynecologic oncology, vol. 170, pp. 195-202. https://doi.org/10.1016/j.ygyno.2023.01.014

TY - JOUR

T1 - Role of adjuvant therapy in intermediate-risk cervical cancer patients – Subanalyses of the SCCAN study

AU - Cibula, David

AU - Akilli, Huseyin

AU - Jarkovsky, Jiri

AU - van Lonkhuijzen, Luc

AU - Scambia, Giovanni

AU - Meydanli, Mehmet Mutlu

AU - Ortiz, David Isla

AU - Falconer, Henrik

AU - Abu-Rustum, Nadeem R.

AU - Odetto, Diego

AU - Klát, Jaroslav

AU - dos Reis, Ricardo

AU - Zapardiel, Ignacio

AU - di Martino, Giampaolo

AU - Presl, Jiri

AU - Laky, Rene

AU - López, Aldo

AU - Weinberger, Vit

AU - Obermair, Andreas

AU - Pareja, Rene

AU - Poncová, Renata

AU - Mom, Constantijne

AU - Bizzarri, Nicolò

AU - Borčinová, Martina

AU - Aslan, Koray

AU - Salcedo Hernandez, Rosa Angélica

AU - Fons, Guus

AU - Benešová, Klára

AU - Dostálek, Lukáš

AU - Ayhan, Ali

N1 - Funding Information: This work was supported by grants from Charles University in Prague ( COOPERATIO , UNCE 204065 ), Ministry of Health of the Czech Republic ( MH CZ – DRO-VFN64165 ), and the Czech Health Research Council ( NV19-03-00023 ). The funding sources were not involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Publisher Copyright: © 2023 Elsevier Inc.

PY - 2023/3/1

Y1 - 2023/3/1

N2 - Objective: The “intermediate-risk” (IR) group of early-stage cervical cancer patients is characterized by negative 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%) received 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.

AB - Objective: The “intermediate-risk” (IR) group of early-stage cervical cancer patients is characterized by negative 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%) received 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.

KW - Adjuvant treatment

KW - Cervical cancer

KW - GOG criteria

KW - Intermediate risk

KW - Radial surgery

KW - Radiotherapy

UR - https://www.scopus.com/pages/publications/85147455294

U2 - 10.1016/j.ygyno.2023.01.014

DO - 10.1016/j.ygyno.2023.01.014

M3 - Article

C2 - 36706646

SN - 0090-8258

VL - 170

SP - 195

EP - 202

JO - Gynecologic oncology

JF - Gynecologic oncology

ER -

Role of adjuvant therapy in intermediate-risk cervical cancer patients – Subanalyses of the SCCAN study

Abstract

UN SDGs

Keywords

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