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Impact of nodal status and treatment strategy on overall survival in advanced stage cervical cancer

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Purpose

The lack of prognostic data impedes implementation of optimal therapy for cervical cancer. For instance, recommended therapy for FIGO IIB cervical cancer is radical hysterectomy or radiochemotherapy. To enlighten different therapeutic approaches, we investigated the benefit of individual therapies or combination thereof in patients with or without infested lymph nodes.

Methods

The German Tumor Centre Regensburg registered 389 patients with FIGO IIB, IIIA, IIIB, and IVA cervical cancer between 2002 and 2015. We estimated hazard ratios (HR) for overall survival against different therapies using univariable and multivariable cox regression. After risk adjustment with respect to clinicopathological parameters, we performed model selection using conditional stepwise reverse selection.

Results

We demonstrated the need for thorough assessment of the nodal status to obtain reliable data for treatment strategy. Our analysis showed significant differences for overall survival in FIGO IIB depending on therapy and nodal status. Outcome was inferior with radiochemotherapy without surgery for patients with N0 compared to surgery and radiochemotherapy combined (HR 3.012; 95% CI 1.075–8.441; p = 0.036); however, for N1, radiochemotherapy without surgery resulted in comparable outcome (HR 0.808; 95% CI 0.189–3.403; p = 0.765), whereas surgery alone yielded in poor outcome (HR 2.889; 95% CI 1.356–6.156; p = 0.006). Regardless of the nodal status, chemotherapy was superior in advanced stage cervical cancer FIGO III to IVA.

Conclusions

Our study suggests that in terms of oncological outcome FIGO IIB cervical cancer patients benefit from a combination of surgery and radiochemotherapy. However, in the presence of lymph node infestation, surgery does not add substantial benefit to the patient.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Klinikum St. Marien Amberg, Amberg, Germany

    Thomas Papathemelis & Anton Scharl

  2. Department Ob/Gyn, University of Witten-Herdecke, KKH Dormagen, Dormagen, Germany

    Michael Anapolski

  3. Department of Gynecology and Obstetrics, University Medical Center, Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany

    Atanas Ignatov, Elisabeth C. Inwald & Olaf Ortmann

  4. Tumor Center, University of Regensburg, Regensburg, Germany

    Stella Knobloch, Michael Gerken & Monika Klinkhammer-Schalke

  5. Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaninger Straße 22, 81675, Munich, Germany

    Sophia Scharl

Authors
  1. Thomas Papathemelis
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  2. Stella Knobloch
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  3. Michael Gerken
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  4. Anton Scharl
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  5. Michael Anapolski
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  6. Atanas Ignatov
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  7. Elisabeth C. Inwald
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  8. Olaf Ortmann
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  9. Sophia Scharl
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  10. Monika Klinkhammer-Schalke
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Correspondence to Thomas Papathemelis.

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Papathemelis, T., Knobloch, S., Gerken, M. et al. Impact of nodal status and treatment strategy on overall survival in advanced stage cervical cancer. J Cancer Res Clin Oncol 145, 1369–1376 (2019). https://doi.org/10.1007/s00432-019-02890-7

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  • DOI: https://doi.org/10.1007/s00432-019-02890-7

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