Propensity score-matched analysis of systemic chemotherapy versus salvage hysterectomy for persistent cervical cancer after definitive radiotherapy/concurrent chemoradiotherapy
Munetaka Takekuma,
Fumiaki Takahashi,
Seiji Mabuchi,
Wataru Kudaka,
Koji Horie,
Mariko Ikeda,
Ayumi Shikama,
Akira Mitsuhashi,
Shoji Nagao,
Shiro Suzuki,
Mika Mizuno,
Shin Nishio,
Hideki Tokunaga,
Yukinobu Ota,
Takahiro Kasamatsu,
Ryo Kitagawa,
Takafumi Toita,
Hiroaki Kobayashi,
Mitsuya Ishikawa,
Nobuo Yaegashi
Affiliations
Munetaka Takekuma
Department of Gynecology, Shizuoka Cancer Center
Fumiaki Takahashi
Department of Information Science, Iwate Medical University
Seiji Mabuchi
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine
Wataru Kudaka
Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus
Koji Horie
Department of Gynecology, Saitama Cancer Center
Mariko Ikeda
Department of Gynecology, Kanagawa Cancer Center
Ayumi Shikama
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba
Akira Mitsuhashi
Departments of Reproductive Medicine, Graduate School of Medicine, Chiba University
Shoji Nagao
Department of Gynecologic Cancer, Hyogo Cancer Center
Shiro Suzuki
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine
Mika Mizuno
Department of Gynecology, Aichi Cancer Center Hospital
Shin Nishio
Department of Obstetrics and Gynecology, Kurume University School of Medicine
Hideki Tokunaga
Department of Obstetrics and Gynecology, Tohoku University Hospital
Yukinobu Ota
Department of Gynecology, Osaka International Cancer Institute
Takahiro Kasamatsu
Department of Obstetrics and Gynecology, Tokyo Metropolitan Bokutoh Hospital
Ryo Kitagawa
Department of Gynecology and Obstetrics, Tohoku Medical and Pharmaceutical University
Takafumi Toita
Radiation Therapy Center, Okinawa Chubu Hospital
Hiroaki Kobayashi
Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University
Mitsuya Ishikawa
Department of Gynecology, National Cancer Center Hospital
Nobuo Yaegashi
Department of Obstetrics and Gynecology, Tohoku University Hospital
Abstract Background The aim of the current study was to evaluate oncologic outcomes of patients who were treated with salvage hysterectomy (HT), compared to systemic chemotherapy (CT) for persistent cervical cancer after definitive radiotherapy (RT)/ concurrent chemoradiotherapy (CCRT). Methods Patients with persistent cervical cancer treated with definitive RT/CCRT at 35 institutions from 2005 to 2014 were reviewed retrospectively (n = 317). Those who underwent a HT for persistent cervical cancer after definitive RT/CCRT were matched with propensity scores for patients who underwent systemic CT. Oncologic outcomes between the two groups using a propensity score matched–cohort analysis were compared. Results A total of 142 patients with persistent cervical cancer after definitive RT/CCRT were included after matching (HT: 71, systemic CT: 71). All background factors between HT and CT groups were well balanced. Median overall survival was 3.8 and 1.5 years in the HT and CT groups, respectively (p = 0.00193, hazards ratio [HR] 0.41, 95% confidence interval [CI] 0.23–0.73), Increasing residual tumor size was significantly associated with a high incomplete resection rate (p = 0.016, Odds Ratio 1.11, 95%CI 1.02–1.22). Severe late adverse events occurred in 7 patients (9.9%) in the HT cohort. Conclusion The current study demonstrated that, when compared to systemic CT, the adoption of salvage HT for patients with persistent cervical cancer after definitive RT/CCRT reduced mortality rate by about 60%. This indicates that salvage HT could be curative treatment for those patients. Further prospective clinical trials with regard to salvage HT after RT/CCRT are warranted.
