[Outcomes and prognostic factors of advanced squamous cervical cancer after concurrent chemoradiotherapy]

To evaluate the outcomes and the prognostic factors for advanced squamous cervical cancer after concurrent chemoradiotherapy (CCRT).

Totally 172 patients with International Federation of Gynecology and Obstetrics stage IIb-IV who were treated in Cancer Hospital, Chinese Academy of Medical Sciences between January 2007 and December 2008 were retrospectively analyzed. Patients were received external radiotherapy, high-dose rate brachytherapy and cisplatin-based chemotherapy concurrently.

The median follow-up period was 54.5 months. The 2-year and 5-year overall survival (OS) were separately 81.5% and 68.8%. The 2-year and 5-year progress-free survival (PFS) were separately 69.2% and 63.1%. Using univariate analysis followed with multivariate analysis, the results showed that these clinicopathological factors including stage (III and above versus IIb; P = 0.021, HR = 1.95; P = 0.020, HR = 1.86), maximum diameter of local tumor size (>4 versus ≤ 4 cm; P = 0.009, HR = 2.55; P = 0.033, HR = 1.94), squamous cell carcinoma antigen (SCC) level before treatment (>3 versus ≤ 3 µg/L; P = 0.010, HR = 2.47; P = 0.013, HR = 2.09) and retroperitoneal lymph node status on imaging (para-aortic lymph node positive versus negative, P = 0.009, HR = 3.00, P = 0.010, HR = 2.74; pelvic lymph node positive only versus negative, P = 0.044, HR = 1.98, P = 0.033, HR = 1.92) had the significant effect on OS and PFS. Patients with no above adverse prognostic factor were assigned to Group A (n = 18), those with one factor were assigned to Group B (n = 43), and those with no less than two factors were assigned to Group C (n = 111). Among three groups, the 2-year OS were separately 94.1%, 97.7% and 73.1%, the 5-year OS were separately 81.4%, 90.1% and 58.6%, the 2-year PFS were separately 88.2%, 90.4% and 57.9%, the 5-year PFS were 82.4%, 87.9% and 50.0%. The results showed that group C was significant difference from Group A or B in OS and PFS (all P < 0.05), while Group A had no significant difference from Group B in OS and PFS (P > 0.05).

Stage III or above, maximum diameter of local tumor size >4 cm, SCC level >3 µg/L before treatment and positive retroperitoneal lymph nodes on imaging are four independent adverse factors for prognosis of squamous cervical cancer of advanced stage after CCRT. The treatment of patients with no less than two adverse factors should be considered to be improved.