TY - JOUR
T1 - Beyond Sedlis—A novel histology-specific nomogram for predicting cervical cancer recurrence risk
T2 - An NRG/GOG ancillary analysis
AU - Levinson, Kimberly
AU - Beavis, Anna L.
AU - Purdy, Christopher
AU - Rositch, Anne F.
AU - Viswanathan, Akila
AU - Wolfson, Aaron H.
AU - Kelly, Michael G.
AU - Tewari, Krishnansu S.
AU - McNally, Leah
AU - Guntupalli, Saketh R.
AU - Ragab, Omar
AU - Lee, Yi Chun
AU - Miller, David S.
AU - Huh, Warner K.
AU - Wilkinson, Kelly J.
AU - Spirtos, Nicola M.
AU - Van Le, Linda
AU - Casablanca, Yovanni
AU - Holman, Laura L.
AU - Waggoner, Steven E.
AU - Fader, Amanda N.
N1 - Funding Information:
This study was supported by National Institute of Health grants to NRG Oncology (1 U10 CA180822) and NRG Operations (U10CA180868). The following Gynecologic Oncology Group member institutions participated in the primary treatment studies: University of Miami School of Medicine, Wake Forest University Health Sciences, University of California Medical Center at Irvine-Orange Campus, Duke University Medical Center, University of Colorado Cancer Center – Anschulz Cancer Pavilion, University of Southern California, State University of New York Downstate Medical Center, University of Texas Southwestern Medical Center, University of Alabama at Birmingham, University of Mississippi Medical Center, Women's Cancer Center of Nevada, University of North Carolina at Chapel Hill, Walter Reed National Military Medical Center, University of Oklahoma Health Sciences Center, Oregon Health Sciences University, Rush University Medical Center, University of California at Los Angeles Health System, Abington Memorial Hospital-Asplundh Cancer Pavilion, Georgetown University Hospital, Indiana University Hospital/Melvin and Brem Simon Cancer Center, Stanford University Medical Center, Albany Medical College, University of Michigan Medical School, University of Minnesota Medical Center-Fairview, LDS Hospital, Penn State Milton S. Hershey Medical Center, University Hospital of Jacksonville, Tufts-New England Medical Center, University of Pittsburgh Cancer Institute (UPCI), Ohio State University Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, University of Connecticut, University of Puerto Rico, University of Rochester Medical Center, University of Cincinnati, Washington University School of Medicine, University of Utah Medical Center, St. Louis University Medical Center, Moffitt Cancer Center and Research Institute, Gynecologic Oncology Network/Brody School of Medicine, Eastern Pennsylvania GYN/ONC Center, P.C. Medical University of South Carolina, University of Kentucky, Community Clinical Oncology Program, Fox Chase Cancer Center, Abramson Cancer Center of the University of Pennsylvania, Cooper Hospital University Medical Center, University of Virginia, Temple University School of Medicine, Cleveland Clinic Foundation, Stony Brook University Medical Center, Tacoma General Hospital, Mayo Clinic, Eastern Virginia Medical School, University of Massachusetts Memorial Health Care, University of Chicago, Thomas Jefferson University Hospital, University of Toronto/Sunnybrook Regional Cancer Centre, Emory University Clinic, Fred Hutchinson Cancer Research Center, Johns Hopkins Oncology Center, MD Anderson Cancer Center and University of Arizona.
Funding Information:
This study was supported by National Institute of Health grants to NRG Oncology ( 1 U10 CA180822 ) and NRG Operations ( U10CA180868 ).
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/9
Y1 - 2021/9
N2 - Purpose: 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. Methods: 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. Results: 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. Conclusions: 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.
AB - Purpose: 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. Methods: 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. Results: 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. Conclusions: 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.
KW - Adenocarcinoma
KW - Adjuvant radiation
KW - Cervical cancer
KW - Stage I
UR - http://www.scopus.com/inward/record.url?scp=85108997734&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2021.06.017
DO - 10.1016/j.ygyno.2021.06.017
M3 - Article
C2 - 34217544
AN - SCOPUS:85108997734
SN - 0090-8258
VL - 162
SP - 532
EP - 538
JO - Gynecologic Oncology
JF - Gynecologic Oncology
IS - 3
ER -