Beyond Sedlis—A novel histology-specific nomogram for predicting cervical cancer recurrence risk: An NRG/GOG ancillary analysis

Kimberly Levinson*, Anna L. Beavis, Christopher Purdy, Anne F. Rositch, Akila Viswanathan, Aaron H. Wolfson, Michael G. Kelly, Krishnansu S. Tewari, Leah McNally, Saketh R. Guntupalli, Omar Ragab, Yi Chun Lee, David S. Miller, Warner K. Huh, Kelly J. Wilkinson, Nicola M. Spirtos, Linda Van Le, Yovanni Casablanca, Laura L. Holman, Steven E. WaggonerAmanda N. Fader

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


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.

Original languageEnglish
Pages (from-to)532-538
Number of pages7
JournalGynecologic Oncology
Issue number3
StatePublished - Sep 2021
Externally publishedYes


  • Adenocarcinoma
  • Adjuvant radiation
  • Cervical cancer
  • Stage I


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