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Abstract：
To analyze recurrent factors in patients with clinical early-stage cervical cancer (ESCC) following hysterectomy and adjuvant radiotherapy.
We collected data from patients with ESCC, staged according to the 2009 Federation International of Gynecology and Obstetrics (FIGO) staging criteria, who underwent hysterectomy followed by adjuvant radiotherapy between 2012 and 2019. These patients were subsequently restaged using the 2018 FIGO criteria. Univariable and multivariable analyses, along with nomogram analyses, were conducted to explore factors associated with recurrence-free survival (RFS).
A total of 310 patients met the inclusion criteria, with a median follow-up time of 46 months. Among them, 126 patients with ESCC were restaged to stage III C1 or III C2 after surgery due to lymph node metastasis (LNM) based on the 2018 FIGO staging criteria. Of these, 60 (19.3%) experienced relapse. The 1-, 3-, and 5-year RFS rates were 93.9%, 82.7%, and 79.3%, respectively. Multivariate analysis revealed that the number of positive lymph nodes (LNs), tumor diameter (TD) > 4 cm, and parametrial invasion (PI) were associated with recurrence. The nomogram indicated their predictive value for 3-year and 5-year RFS. Notably, the 5-year recurrence rate (RR) increased by 30.2% in patients with LNM, particularly those with ≥ 3 positive LNs (45.5%). Patients with stage III C2 exhibited a significantly higher RR than those with IIIC1 (56.5% vs. 24.3%, p < 0.001). The 5-year RFS for patients with TD > 4 cm was 65.8%, significantly lower than for those with TD ≤ 4 cm (88.2%). Subgroup analysis revealed higher 5-year RRs in patients with stage III C2 than that in patients with III-C1 (56.5% vs. 24.3%, p < 0.001), demonstrating a significant difference in the RFS survival curve.
RR in patients with clinical ESCC after hysterectomy followed by adjuvant radiotherapy is correlated with the number of positive LNs, TD > 4 cm, and PI. Emphasis should be placed on the common high-risk factor of LNM association with recurrence after radical hysterectomy in ESCC.
We collected data from patients with ESCC, staged according to the 2009 Federation International of Gynecology and Obstetrics (FIGO) staging criteria, who underwent hysterectomy followed by adjuvant radiotherapy between 2012 and 2019. These patients were subsequently restaged using the 2018 FIGO criteria. Univariable and multivariable analyses, along with nomogram analyses, were conducted to explore factors associated with recurrence-free survival (RFS).
A total of 310 patients met the inclusion criteria, with a median follow-up time of 46 months. Among them, 126 patients with ESCC were restaged to stage III C1 or III C2 after surgery due to lymph node metastasis (LNM) based on the 2018 FIGO staging criteria. Of these, 60 (19.3%) experienced relapse. The 1-, 3-, and 5-year RFS rates were 93.9%, 82.7%, and 79.3%, respectively. Multivariate analysis revealed that the number of positive lymph nodes (LNs), tumor diameter (TD) > 4 cm, and parametrial invasion (PI) were associated with recurrence. The nomogram indicated their predictive value for 3-year and 5-year RFS. Notably, the 5-year recurrence rate (RR) increased by 30.2% in patients with LNM, particularly those with ≥ 3 positive LNs (45.5%). Patients with stage III C2 exhibited a significantly higher RR than those with IIIC1 (56.5% vs. 24.3%, p < 0.001). The 5-year RFS for patients with TD > 4 cm was 65.8%, significantly lower than for those with TD ≤ 4 cm (88.2%). Subgroup analysis revealed higher 5-year RRs in patients with stage III C2 than that in patients with III-C1 (56.5% vs. 24.3%, p < 0.001), demonstrating a significant difference in the RFS survival curve.
RR in patients with clinical ESCC after hysterectomy followed by adjuvant radiotherapy is correlated with the number of positive LNs, TD > 4 cm, and PI. Emphasis should be placed on the common high-risk factor of LNM association with recurrence after radical hysterectomy in ESCC.
摘要：
目的：分析临床早期宫颈癌(ESCC)患者行子宫切除及放疗后复发的影响因素。
方法：我们收集了ESCC患者的数据，根据2009年国际妇产科联合会(FIGO)分期标准分期，在2012年至2019年期间接受了子宫切除术后的辅助放疗。这些患者随后使用2018年FIGO标准进行了重新治疗。单变量和多变量分析，连同列线图分析，进行了探讨与无复发生存（RFS）相关的因素。
结果：共有310例患者符合纳入标准，中位随访时间为46个月。其中,根据2018年FIGO分期标准，126例ESCC患者因淋巴结转移（LNM）在手术后恢复至III期C1或III期C2。其中,60例（19.3%）复发。1-,3-,5年RFS率为93.9%，82.7%,和79.3%，分别。多因素分析显示，阳性淋巴结（LNs）的数量，肿瘤直径（TD）>4厘米，和宫旁浸润（PI）与复发有关。列线图显示了它们对3年和5年RFS的预测价值。值得注意的是,LNM患者的5年复发率（RR）增加了30.2%，特别是LN≥3（45.5%）。III期C2患者的RR明显高于IIIC1患者（56.5％vs.24.3%,p<0.001)。TD>4cm患者的5年RFS占65.8%,显著低于TD≤4cm的(88.2%)。亚组分析显示，III期C2患者的5年RR高于III-C1患者（56.5％vs.24.3%,p<0.001)，证明RFS存活曲线有显著差异。
结论：临床上ESCC患者行子宫切除术后辅助放疗的RR与阳性LN的数量相关，TD>4cm,和PI。应重视ESCC中LNM与根治性子宫切除术后复发的共同高危因素。
方法：我们收集了ESCC患者的数据，根据2009年国际妇产科联合会(FIGO)分期标准分期，在2012年至2019年期间接受了子宫切除术后的辅助放疗。这些患者随后使用2018年FIGO标准进行了重新治疗。单变量和多变量分析，连同列线图分析，进行了探讨与无复发生存（RFS）相关的因素。
结果：共有310例患者符合纳入标准，中位随访时间为46个月。其中,根据2018年FIGO分期标准，126例ESCC患者因淋巴结转移（LNM）在手术后恢复至III期C1或III期C2。其中,60例（19.3%）复发。1-,3-,5年RFS率为93.9%，82.7%,和79.3%，分别。多因素分析显示，阳性淋巴结（LNs）的数量，肿瘤直径（TD）>4厘米，和宫旁浸润（PI）与复发有关。列线图显示了它们对3年和5年RFS的预测价值。值得注意的是,LNM患者的5年复发率（RR）增加了30.2%，特别是LN≥3（45.5%）。III期C2患者的RR明显高于IIIC1患者（56.5％vs.24.3%,p<0.001)。TD>4cm患者的5年RFS占65.8%,显著低于TD≤4cm的(88.2%)。亚组分析显示，III期C2患者的5年RR高于III-C1患者（56.5％vs.24.3%,p<0.001)，证明RFS存活曲线有显著差异。
结论：临床上ESCC患者行子宫切除术后辅助放疗的RR与阳性LN的数量相关，TD>4cm,和PI。应重视ESCC中LNM与根治性子宫切除术后复发的共同高危因素。
