Impact of different postoperative adjuvant therapies on the survival of early‐stage cervical cancer patients with one intermediate‐risk factor: A multicenter study of 14 years

Ye, Yanna; Li, Zhiqiang; Kang, Shan; Zhan, Xuemei; Zhang, Yi; Xu, Yan; Li, Weili; Lang, Jinghe; Liu, Ping; Chen, Chunlin

doi:10.1111/jog.15632

Cited by 10 publications

(8 citation statements)

References 41 publications

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“…The primary objective of adjuvant therapy extends beyond controlling local recurrence to also aiming at reducing the risk of distant metastases. However, while adjuvant pelvic radiation may lower the incidence of local recurrences [ 12 ], it is not effective in preventing distant metastases [ 13 ], which contributes to the limited impact of postoperative RT on overall survival [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of chemotherapy as monotherapy in patients with recurrent intermediate/high-risk factors following radical hysterectomy for stage IB-IIA cervical cancer: a single-center retrospective analysis

Dong,

Zhou

2024

BMC Women's Health

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Objective The aim of this study is to explore the efficacy and safety of chemotherapy (CT) as a monotherapy in patients with recurrent intermediate/high-risk factors following radical hysterectomy for stage IB-IIA cervical cancer. Methods A retrospective analysis was conducted on the medical records of patients diagnosed with stage IB-IIA cervical cancer who underwent radical hysterectomy at the People’s Hospital of Suzhou High-tech District between 2010 and 2020. A total of 66 patients with intermediate or high-risk factors for recurrence were treated exclusively with CT. This cohort included 42 patients in the intermediate-risk group and 24 in the high-risk group. Treatment protocols consisted of 4–6 cycles of paclitaxel and cisplatin drugs for the intermediate-risk group, and 6 cycles for the high-risk group. The relapse-free survival (RFS), recurrence rates, and common CT-related adverse reactions, including bone marrow suppression, nausea and vomiting, and diarrhea, were assessed for both groups. Results (1) The cumulative 3-year RFS rates for the intermediate-risk and high-risk groups were 97.3% (36/37) and 82.4% (14/17), respectively, with cumulative 5-year RFS rates of 97.1% (34/35) and 82.4% (14/17), respectively. The Log rank test revealed no significant difference between the two groups (P > 0.05), (χ² = 2.718, P = 0.099). The 5-year recurrence rates in the intermediate-risk and high-risk groups were 2.38% (1/42) and 12.50% (3/24), respectively. (2) The incidence of grade III bone marrow suppression in the intermediate-risk and high-risk groups was 21.19% (11/42) and 25.00% (6/24), respectively, while the incidence of grade IV bone marrow suppression was 11.90% (5/42) and 8.33% (2/24), respectively. There was no statistically significant difference in bone marrow suppression grades between the two groups (P > 0.05). Conclusion CT with paclitaxel and cisplatin, administered as monotherapy post-radical hysterectomy for stage IB-IIA cervical cancer, demonstrates satisfactory survival benefits with an acceptable safety profile. Moreover, no significant differences were observed in prognosis or adverse reactions between the different risk groups treated solely with CT.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of chemotherapy as monotherapy in patients with recurrent intermediate/high-risk factors following radical hysterectomy for stage IB-IIA cervical cancer: a single-center retrospective analysis

Dong,

Zhou

2024

BMC Women's Health

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“…Therefore, adjuvant radio(chemo) therapy is increasingly recommended for these patients, but its actual efficacy is still controversial and designing tailored therapeutic schedules is extremely challenging ( 16 ). A retrospective study has found adjuvant radiotherapy/chemoradiotherapy failed to provide significant benefits for OS or DFS in early-stage CC patients with one intermediate-risk factor ( 17 ). For a considerable proportion of early-stage CC patients with pelvic lymph node metastases, adjuvant radiotherapy concurrent with chemotherapy failed to provide superior survival benefits as compared with chemotherapy alone ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

“…A recent nationwide retrospective study (n=6192) has suggested adjuvant therapies should be cautiously recommended in some of these subpopulation, where adjuvant chemotherapy may be effective in patients with large tumors (31). Another retrospective study has found no significant correlation between postoperative adjuvant therapies and clinical outcomes in stage IA1 to IIA2 CC patients with one intermediate-risk factor (17). However, the opposite result was observed in a study that proved stage I-IIA CC patients could benefit from postoperative chemotherapy or radiotherapy or sequential chemotherapy and radiotherapy (32).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of consolidation chemotherapy after adjuvant therapy in stage IB-IIA cervical cancer patients with risk factors: a retrospective single-center study

Wang,

Guo,

Yang

et al. 2024

Front. Oncol.

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ObjectiveAccumulated evidence has suggested a relatively high recurrence rate in early-stage cervical cancer (CC) patients with risk factors. This study aimed to assess the efficacy and safety of consolidation chemotherapy following adjuvant therapy (concurrent chemoradiotherapy (CCRT) or radiotherapy (RT) alone) in stage IB-IIA CC patients with risk factors.MethodsA total of 237 stage IB-IIA CC patients who received radical surgery between January 2014 and December 2021 were included in the retrospective study. According to the types of adjuvant therapies, the patients were classified into the control group (CCRT or RT alone) and the study group (consolidation chemotherapy following CCRT or RT alone). The propensity score matching (PSM) was used to balance baseline characteristics between the two groups. The primary end points of the study were disease-free survival (DFS) and overall survival (OS).ResultsFor the entire cohort, no significant difference was observed in the DFS or OS between the study and control group, which was also confirmed in the PSM cohort (n=124). The multivariate analysis identified the high-risk factor type was an independent adverse prognostic factor for the patients. In patients with high risk factors, consolidation chemotherapy following adjuvant therapy was significantly associated with better clinical outcomes and identified as an independent prognostic favorable factor. Moreover, this association remained statistically significant in high-risk patients with ≥2 metastatic lymph nodes. In patients with intermediate risk factors, consolidation chemotherapy following adjuvant therapy was unrelated to DFS or OS. The safe assessment demonstrated consolidation chemotherapy following adjuvant therapy was significantly correlated with higher rates of ≥ grade 3 hematologic toxicities in both the global and subgroup analysis stratified by risk factor type.ConclusionConsolidation chemotherapy after adjuvant therapy provided survival benefits in stage IB-IIA CC patients with high risk factors, particularly those with ≥2 metastatic lymph nodes. However, related hematologic toxicities should be alerted in patient management. The actual efficacy and safety of consolidation chemotherapy still need to be investigated in more well-designed clinical trials.

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“…This is due to the adverse events associated with radiation therapy following radical surgery such as lower-limb lymphedema, urinary disturbance, bowel obstruction, sexual dysfunction, and mental health issues caused by the lasting issues of other adverse events, and these are frequently more severe than the extent of adverse events associated with chemotherapy ( 10 ). Additionally, the efficacy of adjuvant chemotherapy has been increasingly reported ( 6 , 10 , 29 ). Additionally, one of the advantages of using chemotherapy as adjuvant therapy is that if radiation therapy is not performed as adjuvant therapy during the primary treatment, it can be used if loco-regional recurrence occurs ( 4 , 10 , 30 ).…”

Section: Discussionmentioning

confidence: 99%

CLPTM1L expression predicts recurrence of patients with intermediate‑ and high‑risk stage IB‑IIB cervical cancer undergoing radical hysterectomy followed by TP as adjuvant chemotherapy

Awazu

Fukuda²,

Noda

et al. 2023

Oncol Lett

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According to the National Comprehensive Cancer Network clinical practice guidelines of cervical cancer, concurrent chemoradiotherapy or radiotherapy is suggested for patients who receive radical hysterectomy and have intermediate- and high-risk cervical cancer. However, adjuvant chemotherapy has been increasingly chosen given the adverse events associated with chemoradiotherapy or radiotherapy and the increase in evidence regarding the efficacy of adjuvant chemotherapy. Given that adjuvant chemotherapy is not a standard treatment at present, if recurrence after adjuvant chemotherapy could be predicted, it would assist the decision of gynecological oncologists selecting which adjuvant therapy (chemotherapy or radiation therapy) to use. Cleft lip and palate transmembrane protein 1-like protein (CLPTM1L; also known as cisplatin resistance-related protein 9) is associated with apoptotic mechanisms and is related to the proliferation of the tumor cells and resistance against chemotherapy. In the present study, the association between CLPTM1L expression and recurrence of intermediate- and high-risk stage IB-IIB cervical cancer in patients undergoing radical hysterectomy followed by treatment with cisplatin and paclitaxel (TP) as adjuvant chemotherapy was determined. Patients were divided into two groups: Recurrence group and no-recurrence group. CLPTM1L expression was examined using immunohistochemistry in paraffin-embedded sections using weighted scores. Regarding the characteristics of the patients, a histology of non-squamous cell carcinoma, lymph node metastasis and parametrium invasion were more common in the recurrence group compared with the non-recurrence group. In the recurrence group, CLPTM1L expression was significantly higher than that in the no-recurrence group. Next, patients were divided into low and high-expression groups based on the weighted score with a cut-off value of 6. In the high expression group, patients exhibited a higher rate of recurrence (37.5 vs. 5.1%) and had worse overall survival. Multivariate analysis revealed that high CLPTM1L expression was independently related to recurrence. In in vitro analysis, small interfering RNA-mediated knockdown of CLPTM1L enhanced the sensitivity of cervical cancer cells to cisplatin. In conclusion, the present study revealed that CLPTM1L expression may be a predictive biomarker of recurrence of intermediate- and high-risk stage IB-IIB cervical cancer in patients undergoing radical hysterectomy followed by TP as adjuvant chemotherapy.

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Impact of different postoperative adjuvant therapies on the survival of early‐stage cervical cancer patients with one intermediate‐risk factor: A multicenter study of 14 years

Cited by 10 publications

References 41 publications

Efficacy and safety of chemotherapy as monotherapy in patients with recurrent intermediate/high-risk factors following radical hysterectomy for stage IB-IIA cervical cancer: a single-center retrospective analysis

Efficacy and safety of chemotherapy as monotherapy in patients with recurrent intermediate/high-risk factors following radical hysterectomy for stage IB-IIA cervical cancer: a single-center retrospective analysis

Efficacy and safety of consolidation chemotherapy after adjuvant therapy in stage IB-IIA cervical cancer patients with risk factors: a retrospective single-center study

CLPTM1L expression predicts recurrence of patients with intermediate‑ and high‑risk stage IB‑IIB cervical cancer undergoing radical hysterectomy followed by TP as adjuvant chemotherapy

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