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Metastatic extent-specific prognosis of women with stage IVB cervical cancer: multiple versus single distant organ involvement



Despite the heterogeneity of anatomical sites that metastases may affect, within the current cancer staging schematic, stage IVB encompasses all distant metastasis. This study examined survival outcomes based on the extent of distant organ metastasis in stage IVB cervical cancer.


This retrospective cohort study utilized the National Cancer Institute’s Surveillance, Epidemiology, and End Result Program from 2010 to 2018. The study population included 1772 women with stage IVB cervical cancer who had tumor metastasis to one or more of the following four organs: bone, brain, liver, or lung. Overall survival was assessed based on the metastatic extent in multivariable analysis.


The most common metastatic site was lung (68.3%) followed by bone (35.2%), liver (30.0%), and brain (1.2%). Multiple organ metastases were seen in 26.5% of study population, with lung / liver metastases being the most frequent combination pattern (9.6%) followed by lung / bone (9.4%), and lung / bone / liver (6.4%). A total of 1442 (81.4%) deaths occurred during the follow-up. The cohort-level median overall survival was 7 months, ranging from 3 months in all four organ metastases to 11 months in bone metastasis alone when stratified (absolute difference 8 months, P < 0.001). Multiple organ metastases were independently associated with nearly 50% increased all-cause mortality risk compared to single organ metastasis (adjusted-hazard ratio 1.51, 95% CI 1.34–1.70).


Survival outcomes in those with stage IVB cervical cancer with distant organ involvement can vary based on the extent of metastasis. Incorporation of single versus multiple distant organ metastasis into the cancer staging schema may be valuable (IVB1 versus IVB2).

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Fig. 1

Data availability

All the data that support the findings of this study are publicly available in The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program, and the dataset is available at


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Ensign Endowment for Gynecologic Cancer Research (K.M.). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Conceptualization: KM; data curation: KM; formal analysis: KM; funding acquisition: KM and LDR; investigation: all authors; methodology: KM; project administration: KM; resources: KM; software: KM; supervision: MK and LDR; validation: KM; visualization: KM; writing—original draft: KM, SJ; writing—review & editing: all authors.

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Correspondence to Koji Matsuo.

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All were unrelated to the work: consultant, Quantgene (L.D.R.); none for others.

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University of Southern California (HS-16–00481).

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Abstract presentation: 2022 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer, Phoenix, AZ, March 18–21, 2022.

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Joh, S., Violette, C.J., Khetan, V.U. et al. Metastatic extent-specific prognosis of women with stage IVB cervical cancer: multiple versus single distant organ involvement. Arch Gynecol Obstet 307, 533–540 (2023).

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  • Uterine cervical neoplasms
  • Neoplasm metastasis
  • Survival