Effectiveness of adjuvant systemic chemotherapy for intermediate-risk stage IB cervical cancer

// Koji Matsuo 1, 2, * , Muneaki Shimada 3, 4, * , Harushige Yokota 5 , Toyomi Satoh 6 , Hidetaka Katabuchi 7 , Shoji Kodama 8, 9 , Hiroshi Sasaki 10, 11 , Noriomi Matsumura 12, 13 , Mikio Mikami 14 and Toru Sugiyama 15 1 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA 2 Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA 3 Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan 4 Current affiliation: Department of Obstetrics and Gynecology, Tohoku University, Miyagi, Japan 5 Department of Gynecology, Saitama Cancer Center, Saitama, Japan 6 Department of Obstetrics and Gynecology, University of Tsukuba Faculty of Medicine, Tsukuba, Japan 7 Department of Obstetrics and Gynecology, Faculty of Life Sciences Kumamoto University, Kumamoto, Japan 8 Department of Gynecology, Niigata Cancer Center Hospital, Niigata, Japan 9 Current affiliation: Department of Obstetrics and Gynecology, Niigata Minami Hospital, Niigata, Japan 10 Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Kashiwa, Japan 11 Current affiliation: Department of Gynecology, Chiba Tokushukai Hospital, Funabashi, Japan 12 Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan 13 Current affiliation: Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan 14 Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan 15 Department of Obstetrics and Gynecology, Iwate Medical University, Iwate, Japan * These authors contributed equally to this work Correspondence to: Muneaki Shimada, email: muneaki.shimada.b7@tohoku.ac.jp Koji Matsuo, email: koji.matsuo@med.usc.edu Keywords: cervical cancer, radical hysterectomy, intermediate risk, adjuvant, chemotherapy Received: August 10, 2017      Accepted: September 29, 2017      Published: November 15, 2017 ABSTRACT Objective: To examine the effectiveness of systemic chemotherapy following radical hysterectomy for women with intermediate-risk stage IB cervical cancer. Materials and Methods: This is a retrospective analysis of a previously organized nation-wide cohort study examining 6,003 women with stage IB-IIB cervical cancer who underwent radical hysterectomy between 2004 and 2008 in Japan. Survival of 555 women with stage IB cervical cancer in the intermediate-risk group (deep stromal invasion > 50%, large tumor size > 4 cm, and lympho-vascular space invasion [LVSI]) were examined based on adjuvant therapy patterns: chemotherapy alone ( n = 223, 40.2%), concurrent chemo-radiotherapy ( n = 172, 31.0%), and radiotherapy alone ( n = 160, 28.8%). Results: The most common intermediate-risk pattern was LVSI with deep stromal invasion ( n = 216, 38.5%). The most common chemotherapeutic choice was taxane/platinum (52.2%). Women with adenocarcinoma/adenosquamous histology were more likely to receive chemotherapy ( P = 0.03), and intermediate-risk pattern was not associated with chemotherapy use ( P = 0.11). Women who received systemic chemotherapy had disease-free survival (5-year rate, 88.1% versus 90.2%, adjusted-hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.52–1.83, P = 0.94) and cause-specific survival (95.4% versus 94.8%, adjusted-HR 0.85, 95% CI 0.34–2.07, P = 0.71) similar to those who received concurrent chemo-radiotherapy on multivariable analysis. Similar results were seen among 329 women with multiple intermediate-risk factors (5-year rates for disease-free survival, chemotherapy versus concurrent chemo-radiotherapy, 87.1% versus 90.2%, P = 0.86; and cause-specific survival 94.6% versus 93.4%, P = 0.82). Cumulative local-recurrence ( P = 0.77) and distant-recurrence ( P = 0.94) risks were similar across the adjuvant therapy types. Conclusions: Our study suggests that systemic chemotherapy may be an alternative treatment choice for adjuvant therapy in intermediate-risk stage IB cervical cancer.