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

Authors	CIBULA David AKILLI Huseyin JARKOVSKÝ Jiří VAN LONKHUIJZEN Luc SCAMBIA Giovanni MEYDANLI Mehmet Mutlu ORTIZ David Isla FALCONER Henrik ABU-RUSTUM Nadeem R ODETTO Diego KLAT Jaroslav RICARDO dos Reis ZAPARDIEL Ignacio GIAMPAOLO Di Martino PRESL Jiri LAKY Rene LOPEZ Aldo WEINBERGER Vít OBERMAIR Andreas PAREJA Rene PONCOVA Renata MOM Constantijne BIZZARRI Nicolo BORCINOVA Martina ASLAN Koray HERNANDEZ Rosa Angelica Salcedo FONS Guus BENEŠOVÁ Klára DOSTALEK Lukas AYHAN Ali
Year of publication	2023
Type	Article in Periodical
Magazine / Source	Gynecologic oncology
MU Faculty or unit	Faculty of Medicine
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.