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Risk factors for pelvic and distant recurrence in locally advanced cervical cancer.
Queiroz, Ana Carolina Matos; Fabri, Vanessa; Mantoan, Henrique; Sanches, Solange Moraes; Guimarães, Andréia Paiva Gadelha; Ribeiro, Adriana Regina Gonçalves; da Nogueira Silveira Lima, João Paulo; Chen, Michael Jenwel; Baiocchi, Glauco; da Costa, Alexandre André Balieiro Anastácio.
Afiliação
  • Queiroz ACM; Medical Oncology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.
  • Fabri V; Medical Oncology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.
  • Mantoan H; Gynaecology Oncology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.
  • Sanches SM; Medical Oncology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.
  • Guimarães APG; Medical Oncology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.
  • Ribeiro ARG; Medical Oncology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.
  • da Nogueira Silveira Lima JP; Medical Oncology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.
  • Chen MJ; Radiotherapy Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.
  • Baiocchi G; Gynaecology Oncology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.
  • da Costa AABA; Medical Oncology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil. Electronic address: alexandre.costa@accamargo.org.br.
Eur J Obstet Gynecol Reprod Biol ; 235: 6-12, 2019 Apr.
Article em En | MEDLINE | ID: mdl-30771718
OBJECTIVE: Despite the benefits of concomitant radiotherapy and cisplatin for locally advanced cervical cancer, recurrence rates remain high. New treatment strategies such as consolidation chemotherapy and different concomitant chemotherapy combinations have been tested in recent years. Identification of the best candidates for each treatment strategy could optimize results. STUDY DESIGN: A retrospective review of data from 127 patients with locally advanced cervical cancer (International Federation of Gynecology and Obstetrics Stages IIB-IVA), treated at a single institution from 2005 to 2014. Risk factors for loco-regional and systemic recurrence, and prognostic factors for overall survival (OS) were analysed using Cox regression. Survival of patients treated with consolidation chemotherapy was compared with survival of patients not treated with consolidation chemotherapy in the role cohort and in a propensity-score-matched cohort. RESULTS: With a median follow-up time of 48.7 months, loco-regional-recurrence-free survival (LRFS), distant-metastasis-free survival (DMFS) and OS at 5 years were 76.6%, 54.0% and 63.0%, respectively. On multivariate analysis, tumour size ≥6 cm was associated with shorter LRFS [hazard ratio (HR) 5.18; 95% confidence interval (CI) 1.45-18.45; p = 0.011], and adenocarcinoma (HR 2.48; 95% CI 1.10-5.57; p = 0.028) and positive lymph nodes (HR 2.21; 95% CI 1.303-4.72; p = 0.041) were associated with shorter DMFS. Tumour size ≥6 cm was associated with shorter OS (HR 2.64; 95% CI 1.09-6.35; p = 0.031). Twenty-two patients were treated with consolidation chemotherapy; on univariate analysis, these patients had longer OS compared with patients who were not treated with consolidation chemotherapy (p = 0.043). In a propensity-score-matched cohort, patients treated with consolidation chemotherapy had longer DMFS and OS compared with patients who were not treated with consolidation chemotherapy, although the difference was not significant. CONCLUSIONS: Different risk factors are associated with loco-regional and distant metastases in patients with locally advanced cervical cancer, and could potentially lead to particular therapeutic strategies. Although the number of patients treated with consolidation chemotherapy in the study cohort was small, they seemed to live longer and to have better control of distant relapse then patients who were not treated with consolidation chemotherapy.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Pélvicas / Neoplasias do Colo do Útero / Recidiva Local de Neoplasia Tipo de estudo: Etiology_studies / Evaluation_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Middle aged Idioma: En Revista: Eur J Obstet Gynecol Reprod Biol Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Brasil País de publicação: Irlanda

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Pélvicas / Neoplasias do Colo do Útero / Recidiva Local de Neoplasia Tipo de estudo: Etiology_studies / Evaluation_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Middle aged Idioma: En Revista: Eur J Obstet Gynecol Reprod Biol Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Brasil País de publicação: Irlanda