Race and nodal disease status are prognostic factors in patients with stage IVB cervical cancer

// Shin Nishio 1, 2 , Koji Matsuo 3, 4 , Koji Yonemoto 5 , Mototsugu Shimokawa 6 , Masayuki Hosaka 1 , Michiko Kodama 1 , Takahito M. Miyake 1 , Kimio Ushijima 2 , Toshiharu Kamura 2 , Shannon N. Westin 1 , Pamela T. Soliman 1 and Robert L. Coleman 1 1 Department of Gynecologic Oncology and Reproductive Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA 2 Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Fukuoka, Japan 3 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA 4 Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA 5 Biostatistics Center, Kurume University, Kurume, Fukuoka, Japan 6 Clinical Research Institute, National Kyushu Cancer Center, Fukuoka, Japan Correspondence to: Shin Nishio, email: shinshin@med.kurume-u.ac.jp Keywords: stage IVB; cervical cancer; prognostic factor; African-American; para-aortic chain Received: March 19, 2018 Accepted: July 27, 2018 Published: August 17, 2018 ABSTRACT Background: Patients presenting with stage IVB cervical cancer pose a significant clinical challenge. While previous studies described several poor prognostic factors, they were limited by small sample sizes. The aim of this study was to identify clinicopathological prognostic factors in a large sample of patients with stage IVB cervical cancer at a single institution. Methods: Patients with primary stage IVB cervical cancer diagnosed between 1992 and 2011 were extracted from a search of the MD Anderson Cancer Center registry. Clinicopathological data retrieved from their medical records included demographics (age and race), tumor characteristics (primary lesion size, grade, and histology), TNM classification, and metastatic site (nodal/organ). Treatment approach (radiation, chemotherapy, or both) and intent (palliation or curative) were recorded. Survival rates were evaluated using the Kaplan-Meier method. Cox proportional hazards regression was used to model the association between key variables and overall survival (OS). Results: Two hundred sixty-six patients with stage IVB cervical cancer were identified. Their median OS was 12.7 months. The hazard ratio for African-Americans vs. patients with other ethnicities was 1.76 (95% confidence interval [CI], 1.18–2.54, P= 0.0063), and that for patients with para-aortic nodes alone vs. more extensive metastases was 0.37 (95% CI, 0.26–0.51, P< 0.0001). Other clinicopathological factors were not significantly associated with survival. Conclusions: African-American race was an independent adverse prognostic factor in this cohort. On the other hand, nodal disease in the para-aortic chain alone predicted a favorable prognosis.