Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America.
Gynecol Oncol. 2021 Sep;162(3):532-538. doi: 10.1016/j.ygyno.2021.06.017. Epub 2021 Jul 1.
The Sedlis criteria define risk factors for recurrence warranting post-hysterectomy radiation for early-stage cervical cancer; however, these factors were defined for squamous cell carcinoma (SCC) at an estimated recurrence risk of ≥30%. Our study evaluates and compares risk factors for recurrence for cervical SCC compared with adenocarcinoma (AC) and develops histology-specific nomograms to estimate risk of recurrence and guide adjuvant treatment.
We performed an ancillary analysis of GOG 49, 92, and 141, and included stage I patients who were surgically managed and received no neoadjuvant/adjuvant therapy. Multivariable Cox proportional hazards models were used to evaluate independent risk factors for recurrence by histology and to generate prognostic histology-specific nomograms for 3-year recurrence risk.
We identified 715 patients with SCC and 105 with AC; 20% with SCC and 17% with AC recurred. For SCC, lymphvascular space invasion (LVSI: HR 1.58, CI 1.12-2.22), tumor size (TS ≥4 cm: HR 2.67, CI 1.67-4.29), and depth of invasion (DOI; middle 1/3, HR 4.31, CI 1.81-10.26; deep 1/3, HR 7.05, CI 2.99-16.64) were associated with recurrence. For AC, only TS ≥4 cm, was associated with recurrence (HR 4.69, CI 1.25-17.63). For both histologies, there was an interaction effect between TS and LVSI. For those with SCC, DOI was most associated with recurrence (16% risk); for AC, TS conferred a 15% risk with negative LVSI versus a 25% risk with positive LVSI.
Current treatment standards are based on the Sedlis criteria, specifically derived from data on SCC. However, risk factors for recurrence differ for squamous cell and adenocarcinoma of the cervix. Histology-specific nomograms accurately and linearly represent risk of recurrence for both SCC and AC tumors and may provide a more contemporary and tailored tool for clinicians to base adjuvant treatment recommendations to their patients with cervical cancer.
Sedlis 标准定义了早期宫颈癌子宫切除术后需要放疗的复发危险因素；然而，这些因素是针对鳞状细胞癌 (SCC) 定义的，复发风险估计≥30%。我们的研究评估并比较了 SCC 与腺癌 (AC) 的复发危险因素，并制定了组织学特异性列线图来估计复发风险并指导辅助治疗。
我们对 GOG 49、92 和 141 进行了辅助分析，纳入了接受手术治疗且未接受新辅助/辅助治疗的 I 期患者。多变量 Cox 比例风险模型用于评估组织学的独立复发危险因素，并为 3 年复发风险生成预测组织学特异性列线图。
我们共纳入了 715 例 SCC 患者和 105 例 AC 患者；20%的 SCC 患者和 17%的 AC 患者复发。对于 SCC，淋巴血管间隙侵犯 (LVSI：HR 1.58，CI 1.12-2.22)、肿瘤大小 (TS≥4cm：HR 2.67，CI 1.67-4.29) 和浸润深度 (DOI；中 1/3，HR 4.31，CI 1.81-10.26；深 1/3，HR 7.05，CI 2.99-16.64) 与复发相关。对于 AC，仅 TS≥4cm 与复发相关 (HR 4.69，CI 1.25-17.63)。对于两种组织学类型，TS 和 LVSI 之间存在交互作用。对于 SCC 患者，DOI 与复发相关性最强 (16%的风险)；对于 AC，TS 与阴性 LVSI 相比，阳性 LVSI 与 15%的风险相比，风险增加了 25%。
目前的治疗标准基于 Sedlis 标准，特别是基于 SCC 数据得出的标准。然而，SCC 和宫颈癌的腺癌的复发危险因素不同。组织学特异性列线图准确且线性地表示 SCC 和 AC 肿瘤的复发风险，可能为临床医生提供更现代和量身定制的工具，根据患者的宫颈癌情况为其提供辅助治疗建议。
