PROGNOSTIC FACTORS IN PATIENTS WITH LOCALLY ADVANCED UTERINE CERVICAL CANCER TREATED WITH RADIOTHERAPY AS A PRIMARY TREATMENT

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Abstract

Background

The aim of the present study was to assess prognostic factors for patients with locally advanced cervical cancer treated with radiotherapy as a primary treatment and to assess post-treatment squamous cell carcinoma (SCC) antigen cut-off levels to predict the 3-year survival.

Methods

One hundred sixteen patients with squamous cell carcinoma of the cervix (FIGO stage IIB-IVA) with radiotherapy or concurrent chemoradiotherapy (CCRT) were analyzed retrospectively. Kaplan–Meier life table analysis and the log-rank test were used to assess the survival rate and differences according to the prognostic factors. Multivariate analysis of the prognostic factors for overall survival (OS) was done using the Cox proportional hazards regression model.

Results

The median age was 68 years (range: 27–79 years). The complete response rate was 70.7% and the 3-year OS rate was 61.1%. The median level of pretreatment SCC was 11.5 ng/ml (range: 1.6–310 ng/ml), and post-treatment SCC decreased significantly to 0.9 ng/ml (range: 0.4–41.0 ng/ml) (P = 0.001). On univariate analysis, FIGO stage (P = 0.041), pretreatment hemoglobin levels <10.5 g/dl (P = 0.001), pelvic lymph node metastasis (P = 0.001), tumor size >40 mm (P = 0.001), CCRT (P = 0.016) and posttreatment SCC levels >1.5 ng/ml (P = 0.001) were a significant prognostic factor for overall survival. Of these, pretreatment anemia (P = 0.041), pelvic lymph node metastasis (P = 0.016) and posttreatment SCC (P = 0.001) were independent prognostic factors on multivariate analysis. The SCC level cut-off point for the 3-year OS calculated using a receiver operating characteristic curve was 1.15 ng/ml (sensitivity 80.0%, specificity 74.0%).

Conclusion

In cases of locally advanced cervical cancer treated with radiotherapy, patients with pretreatment anemia, positive for pelvic lymph node metastasis and post-treatment SCC levels >1.5 ng/ml had a poor prognosis. Furthermore, post-treatment SCC level of 1.15 ng/ml or less predicted 3-year survival.

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