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Risk assessment in the patients with uterine cervical cancer harboring intermediate risk factors after radical hysterectomy: a multicenter, retrospective analysis by the Japanese Gynecologic Oncology Group

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A Correction to this article was published on 11 July 2022

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Abstract

Background

Adjuvant therapy is usually considered for surgically treated patients with uterine cervical cancer harboring intermediate risk (IR) factors such as large tumor diameter, stromal invasion to the outer half, and lymphovascular space invasion (LVSI). However, the indications and types of adjuvant therapy for the IR group remain controversial. This study aimed to analyze the differences in patient outcomes in the IR group to provide novel insights for tailoring adjuvant therapy.

Methods

Data from 6192 patients with cervical cancer who underwent radical hysterectomy at 116 institutions belonging to the Japanese Gynecologic Oncology Group were reviewed.

Results

In total, 1688 patients were classified into the IR group, of whom 37.3% did not receive adjuvant therapy. Conversely, approximately equal proportions of the remaining patients received adjuvant radiotherapy, concurrent chemoradiotherapy, and chemotherapy. Patients with all three risk factors showed worse overall survival than those with one or two risk factors. In addition to LVSI, non-squamous cell carcinoma histology, and vaginal invasion were identified as independent risk factors for both recurrence and mortality in multivariate analyses. Tumor diameter greater than 40 mm and surgical center volume were identified as independent risk factors for recurrence. Stromal invasion to the outer half and ovarian metastasis were identified as independent risk factors for mortality.

Conclusions

This study revealed the significant differences in prognosis in the IR group. The indications for adjuvant therapy should be further studied, focusing on conventional risk factors and other pathological findings.

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Acknowledgements

This project was financially supported by the JSPS KAKENHI (JP17K11265 to M.S.). The authors would like to thank all of the participants from the JGOG. We also would like to thank Editage for English language editing.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Shogo Shigeta, Muneaki Shimada, Keita Tsuji & Tomoyuki Nagai

  2. Department of Gynecology, Cancer Institute Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Yasuhito Tanase

  3. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD520, Los Angeles, CA, 9033, USA

    Koji Matsuo

  4. Norris Comprehensive Cancer Center, University of Southern California, 2020 Zonal Avenue, IRD520, Los Angeles, CA, 9033, USA

    Koji Matsuo

  5. Department of Gynecologic Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan

    Shoji Kamiura

  6. Department of Obstetrics and Gynecology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8282, Japan

    Takashi Iwata

  7. Department of Gynecology, Saitama Cancer Center, 780, Oazakomuro, Ina-machi, Kitaadachi-gun, Saitama, Japan

    Harushige Yokota

  8. Department of Obstetrics and Gynecology, Tokai University, 143, Shimokasuya, Isehara, Kanagawa, Japan

    Mikio Mikami

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  1. Shogo Shigeta
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Corresponding author

Correspondence to Muneaki Shimada.

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Conflict of interest

KM and HY: received honoraria from Chugai Pharmaceutical. The other authors have no conflict of interest to disclose regarding this study.

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Supplementary Information

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10147_2022_2198_MOESM1_ESM.pptx

Supplementary file1 Comparison of patient outcomes among patients who showed double positivity for the intermediate risk factors. Three combination patterns were statistically compared by the log-rank test and post hoc analysis. n.s., not significant; LVSI, lymphovascular space invasion (PPTX 65 KB)

10147_2022_2198_MOESM2_ESM.pptx

Supplementary file2 OS and DFS of patients with s single risk factor by adjuvant therapy. Patient outcomes were compared by the log-rank test. n.s., not significant (PPTX 63 KB)

10147_2022_2198_MOESM3_ESM.pptx

Supplementary file3 OS and DFS of patients with two risk factors by adjuvant therapy. Patient outcomes were compared by the log-rank test. n.s., not significant (PPTX 63 KB)

10147_2022_2198_MOESM4_ESM.pptx

Supplementary file4 OS and DFS of patients with three risk factors by adjuvant therapy. Patient outcomes were compared by the log-rank test. n.s., not significant (PPTX 62 KB)

10147_2022_2198_MOESM5_ESM.pptx

Supplementary file5 Assessment of center volume. One-hundred and sixteen centers were ranked by case volume. Twelve centers, which were in the top 10 percentile and registered approximately one-third of the 6,192 cases, were considered to be high-volume centers in this study (PPTX 40 KB)

10147_2022_2198_MOESM6_ESM.pptx

Supplementary file6 Comparison of DFS in relation to each pathological factor. n.s., not significant; LVSI, lymphovascular space invasion; SCC, squamous cell carcinoma (PPTX 109 KB)

10147_2022_2198_MOESM7_ESM.pptx

Supplementary file7 Comparison of patient outcomes focusing on vaginal invasion and non-SCC histology. Patient outcomes were compared in relation to the number of positive risk factors. (a) Vaginal invasion and non-SCC histology were considered as additional risk factors and integrated with the three conventional risk factors, yielding a total of five risk factors. (b) The influence of the additional risk factors on the outcomes of patients showing positivity for any of one of the conventional risk factors was evaluated (PPTX 108 KB)

Supplementary file8 (DOCX 15 KB)

Supplementary file9 (DOCX 14 KB)

Supplementary file10 (DOCX 18 KB)

Supplementary file11 (DOCX 20 KB)

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Shigeta, S., Shimada, M., Tsuji, K. et al. Risk assessment in the patients with uterine cervical cancer harboring intermediate risk factors after radical hysterectomy: a multicenter, retrospective analysis by the Japanese Gynecologic Oncology Group. Int J Clin Oncol 27, 1507–1515 (2022). https://doi.org/10.1007/s10147-022-02198-6

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  • DOI: https://doi.org/10.1007/s10147-022-02198-6

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