Outcome of multiple high-risk factors on overall survival in adjuvant cervical cancer chemoradiation
PD-0909
Abstract
Outcome of multiple high-risk factors on overall survival in adjuvant cervical cancer chemoradiation
Authors: Zachary Horne1, Stephen Abel1, Sarah Crafton2, Eirwen Miller2, Christopher Morse2, John Nakayama2, Thomas Krivak2, Scott Glaser3, Rodey Wegner1, Ankur Patel1, Sushil Beriwal1
1Allegheny Health Network Cancer Institute, Radiation Oncology, Pittsburgh, USA; 2Allegheny Health Network Cancer Institute, Gynecologic Oncology, Pittsburgh, USA; 3City of Hope National Medical Center, Radiation Oncology, Duarte, USA
Show Affiliations
Hide Affiliations
Purpose or Objective
Standard
adjuvant treatment for cervical cancers involving the lymph nodes, parametria
and/or surgical margins consists of concurrent pelvic chemoradiation. The recent OUTBACK study found no benefit to
the addition of further chemotherapy in this population. Non-squamous cell
histology is also considered to be a risk factor for recurrence. This study
aims to identify the impact of multiple high-risk factors on overall survival
outcomes to identify a patient population that may potentially benefit from
intensified therapy.
Material and Methods
The National Cancer Data Base was
queried for women with surgically resected, high-risk cervical carcinomas
between 2004 and 2017 treated with adjuvant chemoradiation. Kaplan-Meier with log-rank test and Cox proportional
hazards tests were utilized for overall survival (OS) calculations. The
risk-factor sum was assigned one point per risk factor including: positive parametrial
involvement, positive lymph nodes, positive surgical margins, and non-squamous
cell histology.
Results
A total of 7,562 women met
inclusion criteria. Of those, 1,681
(22.2%) had only adenocarcinoma as a risk factor, 1,970 (26.1%) had two risk
factors, 3,228 (42.7%) had three risk factors and 683 (9.0%) had all four risk
factors. Five-year overall survival for women with 1, 2, 3, and 4 risk factors
was 82.0%, 75.4%, 72.1%, and 51.7%, respectively (p<0.001). Among women with 1-3 risk factors, non-squamous
cell histology was predictive of worse 5-year OS in each echelon: 75.6% vs 67.9%;
78.1% vs 72.5%; 70.9% vs 48.7%, respectively (p<0.001).
On Cox multivariable analysis, a
higher number of risk factors were predictive for a statistically significant
increased risk of death along with a number of other factors (Table 1).
Conclusion
The number of high risk factors
that serve as indicators for adjuvant chemoradiation along with non-squamous
cell histology predicts for overall survival in women treated with adjuvant
chemoradiation following radical hysterectomy for cervical cancers. These
factors may be utilized to identify a patient population that may benefit from
treatment intensification in the future.