Research Papers:

Effectiveness of adjuvant systemic chemotherapy for intermediate-risk stage IB cervical cancer

Koji Matsuo, Muneaki Shimada _, Harushige Yokota, Toyomi Satoh, Hidetaka Katabuchi, Shoji Kodama, Hiroshi Sasaki, Noriomi Matsumura, Mikio Mikami and Toru Sugiyama

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Oncotarget. 2017; 8:106866-106875. https://doi.org/10.18632/oncotarget.22437

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Koji Matsuo1,2,*, Muneaki Shimada3,4,*, Harushige Yokota5, Toyomi Satoh6, Hidetaka Katabuchi7, Shoji Kodama8,9, Hiroshi Sasaki10,11, Noriomi Matsumura12,13, Mikio Mikami14 and Toru Sugiyama15

1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA

2Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA

3Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan

4Current affiliation: Department of Obstetrics and Gynecology, Tohoku University, Miyagi, Japan

5Department of Gynecology, Saitama Cancer Center, Saitama, Japan

6Department of Obstetrics and Gynecology, University of Tsukuba Faculty of Medicine, Tsukuba, Japan

7Department of Obstetrics and Gynecology, Faculty of Life Sciences Kumamoto University, Kumamoto, Japan

8Department of Gynecology, Niigata Cancer Center Hospital, Niigata, Japan

9Current affiliation: Department of Obstetrics and Gynecology, Niigata Minami Hospital, Niigata, Japan

10Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Kashiwa, Japan

11Current affiliation: Department of Gynecology, Chiba Tokushukai Hospital, Funabashi, Japan

12Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan

13Current affiliation: Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan

14Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan

15Department of Obstetrics and Gynecology, Iwate Medical University, Iwate, Japan

*These authors contributed equally to this work

Correspondence to:

Muneaki Shimada, email: [email protected]

Koji Matsuo, email: [email protected]

Keywords: cervical cancer, radical hysterectomy, intermediate risk, adjuvant, chemotherapy

Received: August 10, 2017     Accepted: September 29, 2017     Published: November 15, 2017


Objective: To examine the effectiveness of systemic chemotherapy following radical hysterectomy for women with intermediate-risk stage IB cervical cancer.

Materials and Methods: This is a retrospective analysis of a previously organized nation-wide cohort study examining 6,003 women with stage IB-IIB cervical cancer who underwent radical hysterectomy between 2004 and 2008 in Japan. Survival of 555 women with stage IB cervical cancer in the intermediate-risk group (deep stromal invasion > 50%, large tumor size > 4 cm, and lympho-vascular space invasion [LVSI]) were examined based on adjuvant therapy patterns: chemotherapy alone (n = 223, 40.2%), concurrent chemo-radiotherapy (n = 172, 31.0%), and radiotherapy alone (n = 160, 28.8%).

Results: The most common intermediate-risk pattern was LVSI with deep stromal invasion (n = 216, 38.5%). The most common chemotherapeutic choice was taxane/platinum (52.2%). Women with adenocarcinoma/adenosquamous histology were more likely to receive chemotherapy (P = 0.03), and intermediate-risk pattern was not associated with chemotherapy use (P = 0.11). Women who received systemic chemotherapy had disease-free survival (5-year rate, 88.1% versus 90.2%, adjusted-hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.52–1.83, P = 0.94) and cause-specific survival (95.4% versus 94.8%, adjusted-HR 0.85, 95% CI 0.34–2.07, P = 0.71) similar to those who received concurrent chemo-radiotherapy on multivariable analysis. Similar results were seen among 329 women with multiple intermediate-risk factors (5-year rates for disease-free survival, chemotherapy versus concurrent chemo-radiotherapy, 87.1% versus 90.2%, P = 0.86; and cause-specific survival 94.6% versus 93.4%, P = 0.82). Cumulative local-recurrence (P = 0.77) and distant-recurrence (P = 0.94) risks were similar across the adjuvant therapy types.

Conclusions: Our study suggests that systemic chemotherapy may be an alternative treatment choice for adjuvant therapy in intermediate-risk stage IB cervical cancer.

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