SUCCOR Risk: Design and Validation of a Recurrence Prediction Index for Early-Stage Cervical Cancer

Abstract

Objective Based on the SUCCOR study database, our primary objective was to identify the independent clinical pathological variables associated with the risk of relapse in patients with stage IB1 cervical cancer who underwent a radical hysterectomy. Our secondary goal was to design and validate a risk predictive index (RPI) for classifying patients depending on the risk of recurrence. Methods Overall, 1116 women were included from January 2013 to December 2014. We randomly divided our sample into two cohorts: discovery and validation cohorts. The test group was used to identify the independent variables associated with relapse, and with these variables, we designed our RPI. The index was applied to calculate a relapse risk score for each participant in the validation group. Results A previous cone biopsy was the most significant independent variable that lowered the rate of relapse (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.17–0.60). Additionally, patients with a tumor diameter >2 cm on preoperative imaging assessment (OR 2.15, 95% CI 1.33–3.5) and operated by the minimally invasive approach (OR 1.61, 95% CI 1.00–2.57) were more likely to have a recurrence. Based on these findings, patients in the validation cohort were classified according to the RPI of low, medium, or high risk of relapse, with rates of 3.4%, 9.8%, and 21.3% observed in each group, respectively. With a median follow-up of 58 months, the 5-year disease-free survival rates were 97.2% for the low-risk group, 88.0% for the medium-risk group, and 80.5% for the high-risk group (p < 0.001). Conclusion Previous conization to radical hysterectomy was the most powerful protective variable of relapse. Our risk predictor index was validated to identify patients at risk of recurrence.

Survival outcomes of abdominal radical hysterectomy, laparoscopic radical hysterectomy, robot-assisted radical hysterectomy and vaginal radical hysterectomy approaches for early-stage cervical cancer: a retrospective study

“…Moreover, conization may also affect the outcomes. Previous conization in patients undergoing radical hysterectomy was associated with improved DFS and OS compared with that in patients who did not undergo conization [ 31 , 32 ]. At present, the factors that are most important for prognosis in CC are staging, tumour size, lymph node involvement, depth of stromal invasion and type of LVSI [ 33 , 34 ]; additionally, the surgeon’s experience [ 35 ], the tumour free distance [ 36 ], the type of lymphadenectomy [ 37 , 38 ] and the MIS approach should be adopted in selected cases [ 39 , 40 ].…”

The Role of Conization before Radical Hysterectomy in Cervical Cancer including High Risk Factors of Recurrence: Propensity Score Matching

“…Additionally, the recurrence rates for patients who underwent MIS with protective vaginal closure and those who underwent open surgery were comparable (HR 0.63, 95% CI 0.15–2.59, p = 0.52) [ 8 ]. They subsequently reported about significantly lower risk of relapse and death with conization before radical hysterectomy [ 16 , 24 ].…”

Cardiopulmonary Adverse Events of Remimazolam versus Propofol During Cervical Conization: A Randomized Controlled Trial

“…It significantly reduces the risk of relapse and patients mortality before undergoing a severe hysterectomy. 1 , 2 Therefore, it has become a standard practice before radical hysterectomy, 3 usually performed in an office or as a day surgery due to its short duration. Cervical conization can be performed under various anesthesia types, such as local anesthesia, local/regional block anesthesia, spinal anesthesia or general anesthesia.…”