Cervical cancer recurrence: Proposal for a classification based on anatomical dissemination pathways and prognosis

Precise definitions of recurrences and optimal treatment strategy are yet to be clearly defined among patients with cervical cancer (CC). The purpose of this study was to develop a reproducible classification of CC recurrence.

Data of women with FIGO stages I-IV CC treated between January 2000 and January 2015 were retrospectively abstracted from nine French institutions. We proposed a rTNM classification for recurrence: locoregional (rT), nodal (rN), or distant organ (rM). According to rTNM prognosis, we then defined a rSTAGE classification (I, II, IIIA, IIIB, IVA, IVB).

Among the 1028 women treated for FIGO stages I-IV CC during the study period, 216 recurrences were observed (21%). The 3-year survival after recurrence was 38.8%, with a median time to recurrence of 9 months (95% CI, 30.9-48.7). A trend for a lower 3-year survival after recurrence was observed in women with multiple-site vs single-site recurrence (p = 0.1). Among the women in the rT group, a difference in 3-year survival after recurrence was found between rT₁ single site, rT₂ single site and rT₃ single site (p = 0.02). The 3-year survival after recurrence was 69.1%, 49.2%, 37.5%, 34.2%, 23.1% and 24.4% for rStage I, II, IIIA, IIIB, IVA and IVB, respectively (p = 0.007).

rTNM classifications and rSTAGE are discriminatory and allow all recurrence modalities to be classified.