A validation study of new risk grouping criteria for postoperative treatment in stage IB cervical cancers without high-risk factors: Rethinking the Gynecologic Oncology Group criteria

Establishing a Nomogram for Stage IA-IIB Cervical Cancer Patients after Complete Resection

“…(Pecorelli et al, 2009) However, its utility is low in guiding adjuvant therapy (Hricak et al, 2005). Although clinicopathologic factors have been suggested to guide postoperative adjuvant therapy selection, controversy surrounding the independence of these factors for prognosis of cervical cancer patients still exists (Chang et al, 2009;Small et al, 2012). These different results may be due to the heterogeneity of the population enrolled in different studies (Kamura et al, 1992;Yuan et al, 1998;Ho et al, 2004;Singh et al, 2012).…”

“…However, clinicopathologic factors other than FIGO stage, such as lymph node metastasis (LNM) and lymph-vascular space invasion (LVSI), have proven to be relevant to the prognosis of cervical cancer patients (Ho et al, 2004;Pecorelli et al, 2009;Singh et al, 2012). Although NCCN (Grochola et al, 2008)guidelines have suggested that adjuvant therapy should be applied to certain patients with intermediate or high risk factors after surgery, these factors remain controversial in many studies (Kamura et al, 1992;Yuan et al, 1998;Creasman and Kohler, 2004;Ho et al, 2004;Chang et al, 2009;Singh et al, 2012;Williams et al, 2015). Therefore, different opinions on the impact of prognostic factors between studies may lead to various selection criteria for adjuvant therapy, as suggested by researchers (Chang et al, 2009;Small et al, 2012).…”

Evaluation of Clinical and Pathologic Risk Factors May Reduce the Rate of Multimodality Treatment of Early Cervical Cancer

“…This undesirable 2-modality treatment was also reported by others who reported the rate of adjuvant radiation between 10% and 64%, depending on the years of the study and the criteria chosen for radiation. 6,13,[16][17][18][19][20] Historically, adjuvant pelvic RT was indicated in cases of lymph nodes metastasis, positive surgical margins, or PI. In these cases, which are considered high risk because of these prognostic factors, recurrences are more frequent and when one or more of these factors are found, the 5-year survival can drop to 40% to 70%.…”

“…6,16,21,22 Therefore a triage system for either surgery or definitive RT in patients with early cervical cancer, who have a high probability of subsequent radiation treatment, would be of value. Several studies have attempted to define such patients, focusing on preoperative clinical and pathologic prognostic factors 13,16,17,19 ; however, based on the above pathologic criteria, about 50% of the patients will still be treated by both surgery and RT. The aim of this study was to assess the rate of postoperative adjuvant treatment in a large cohort of patients who underwent radical hysterectomy for early cervical cancer and to suggest criteria for the triage of patients who have a high probability of multimodality treatment.…”

“…[10][11][12][13][14][15] The reported rate of adjuvant RT following radical hysterectomy and pelvic lymphadenectomy is 10% to 64%. 6,13,[16][17][18][19][20] Thus, a significant proportion of patients undergo treatment by both modalities with potentially compounding morbidities. Only 2 randomized studies compared radical hysterectomy and surgery plus adjuvant RT, and no randomized study has compared surgery and adjuvant chemoradiation with primary surgery for patients with early-stage cervical cancer.…”