A retrospective comparison of outcome in IB2 and IIA cervical cancer patients treated with primary concurrent chemoradiation versus radical hysterectomy with or without tailored adjuvant therapy

Jang, Tae-Kyu; Shin, So Jin; Chung, Hyewon; Kwon, Sang-Hoon; Cha, Soon-Do; Lee, Eunbi; Shin, Changmin; Cho, Chi-Heum

doi:10.5468/ogs.2017.60.6.549

Cited by 4 publications

(1 citation statement)

References 23 publications

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“…A seven-study meta-analysis by Yan et al [ 16 ] revealed that ARH had obvious advantages over chemoradiotherapy for IB2-IIA CC. Jang et al [ 17 ] conducted a study on FIGO 2009 IB1-IIA CC and found that the oncological prognosis of ARH was significantly superior to that of concurrent chemoradiotherapy (CCRT). Bansal et al [ 18 ] analyzed 4,885 cases of FIGO 2009 IB1-IIA CC and found that when the tumor diameter is < 6 cm, ARH potentially benefits patient survival more than R-CT; when it is > 6 cm, the two are equivalent.…”

Section: Discussionmentioning

confidence: 99%

Treatment of FIGO 2018 stage IIIC cervical cancer with different local tumor factors

Ye,

Li,

Kang

et al. 2023

BMC Cancer

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Background To compare the oncological outcomes of patients with FIGO 2018 stage IIIC cervical cancer (CC) involving different local tumor factors who underwent abdominal radical hysterectomy (ARH), neoadjuvant chemotherapy and radical surgery (NACT), or radical chemoradiotherapy (R-CT). Methods Based on tumor staging, patients with stage IIIC were divided into T1, T2a, T2b, and T3 groups. Kaplan–Meier and Cox proportional hazards regression analysis were used to compare their overall survival (OS) and disease-free survival (DFS) of 5 years. Results We included 4,086 patients (1,117, 1,019, 869, and 1,081 in the T1, T2a, T2b, and T3 groups, respectively). In the T1 group, NACT was correlated with a decrease in OS (hazard ratio [HR] = 1.631, 95% confidence interval [CI]: 1.150–2.315, P = 0.006) and DFS (HR = 1.665, 95% CI: 1.255–2.182, P < 0.001) than ARH. ARH and NACT were not correlated with OS (P = 0.226 and P = 0.921) or DFS (P = 0.343 and P = 0.535) than R-CT. In the T2a group, NACT was correlated with a decrease in OS (HR = 1.454, 95% CI: 1.057–2.000, P = 0.021) and DFS (HR = 1.529, 95% CI: 1.185–1.974, P = 0.001) than ARH. ARH and NACT were not correlated with OS (P = 0.736 and P = 0.267) or DFS (P = 0.714 and P = 0.087) than R-CT. In the T2b group, NACT was correlated with a decrease in DFS (HR = 1.847, 95% CI: 1.347–2.532, P < 0.001) than R-CT nevertheless was not correlated with OS (P = 0.146); ARH was not correlated with OS (P = 0.056) and DFS (P = 0.676). In the T3 group, the OS rates of ARH (n = 10), NACT (n = 18), and R-CT (n = 1053) were 67.5%, 53.1%, and 64.7% (P = 0.941), and the DFS rates were 68.6%, 45.5%, and 61.1%, respectively (P = 0.761). Conclusion R-CT oncological outcomes were not entirely superior to those of NACT or ARH under different local tumor factors with stage IIIC. NACT is not suitable for stage T1, T2a, and T2b. Nevertheless ARH is potentially applicable to stage T1, T2a, T2b and T3. The results of stage T3 require confirmation through further research due to disparity in case numbers in each subgroup.

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Section: Discussionmentioning

confidence: 99%

Treatment of FIGO 2018 stage IIIC cervical cancer with different local tumor factors

Ye,

Li,

Kang

et al. 2023

BMC Cancer

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Primary radical hysterectomy vs chemoradiation for IB2-IIA cervical cancer

Yan¹,

Zeng²,

Liu³

et al. 2020

Medicine

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Background: To compare the clinical outcomes of radical hysterectomy (RH) with chemoradiotherapy (CRT) in women with stage IB2-IIA cervical cancer. Methods: Based on articles published up to December 2017, a literature search of PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and Chinese National Knowledge Infrastructure (CNKI) databases was conducted to identify eligible studies. Overall survival (OS), progression-free survival (PFS) with hazard ratios (HRs), and toxicities with odds ratios (ORs) were analyzed. Results: In total, 7 studies comprising 687 patients were identified for this meta-analysis. RH showed a significant trend toward improved survival outcomes compared with those of CRT, regardless of OS (HR = 0.49, 95% confidence interval [CI] 0.36–0.67, P < .001); or PFS (1.61, 95% CI 1.15–2.26, P = .005) for IB2-IIA cervical cancer. Subgroup analysis revealed that stage IB2 cervical cancer patients obtained better OS (HR = 0.36, 95% CI 0.23–0.56, P < .001; heterogeneity: P = .32, I 2 = 13%). However, a higher incidence of grade 3/4 genitourinary abnormalities was evident with RH (OR = 2.3, 95% CI 1.42–3.87, P = .021). Conclusion: Our study suggested that RH had distinct advantages over CRT for carcinoma of the uterine cervix with FIGO stage IB2-IIA, especially for IB2 cervical cancer.

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Abdominal Radical Hysterectomy as an Alternative Treatment Option for Patients with Cervical Cancer without Access to Radiotherapy Facilities

Ye,

Li,

Chen

et al. 2023

Clin. Exp. Obstet. Gynecol.

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Background: To compare the oncological outcomes of Chinese patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIIC cervical cancer (CC) receiving radical chemoradiotherapy (R-CT), abdominal radical hysterectomy (ARH), or neoadjuvant chemotherapy and radical surgery (NACT). Methods: Overall, 4086 patients in 47 hospitals from 2004 to 2018 were divided into groups according to stage (4029 with stage IIIC1 and 57 with stage IIIC2). Kaplan-Meier and Cox regression analyses were applied to compare the 5-year overall survival (OS) and disease-free survival (DFS) of the three initial treatments before and after propensity score matching (PSM). Results: The 5-year DFS was worse in patients with stage IIIC2 than in those with stage IIIC1 (post-PSM: 68.3% vs. 39.9%, p < 0.001). For stage IIIC1, the ARH group had better 5-year OS (post-PSM: 71.0% vs. 80.0%, p < 0.001) and DFS (post-PSM: 67.2% vs. 71.0%, p < 0.001) than the R-CT group, while the NACT group had worse 5-year DFS (post-PSM: 67.7% vs. 55.3%, p = 0.002). The 5-year OS (post-PSM: 80.9% vs. 70.5%, p < 0.001) and DFS (post-PSM: 70.7% vs. 54.1%, p < 0.001) were better in the ARH than in the NACT group. For stage IIIC2, the 5-year DFS was better in the ARH than in the NACT group (45.4% vs. 30.1%, p = 0.025). Conclusions: The oncological prognosis of patients with stage IIIC1 CC was generally better than that of patients with stage IIIC2, thereby supporting the rationale behind the classification of stage IIIC. In less developed areas, the ARH is a promising alternative treatment option for patients with stage IIIC; nonetheless, the use of NACT is not advisable. Clinical Trial Registration: The study was registered at http://apps.who.int/trialsearch/, registration number CHiCTR1800017778.

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A retrospective comparison of outcome in IB2 and IIA cervical cancer patients treated with primary concurrent chemoradiation versus radical hysterectomy with or without tailored adjuvant therapy

Cited by 4 publications

References 23 publications

Treatment of FIGO 2018 stage IIIC cervical cancer with different local tumor factors

Treatment of FIGO 2018 stage IIIC cervical cancer with different local tumor factors

Primary radical hysterectomy vs chemoradiation for IB2-IIA cervical cancer

Abdominal Radical Hysterectomy as an Alternative Treatment Option for Patients with Cervical Cancer without Access to Radiotherapy Facilities

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