Prognostic factors of locally advanced cervical cancer after concurrent chemoradiotherapy: a retrospective study

To investigate the prognostic value of magnetic resonance imaging (MRI) features and clinical features in locally advanced cervical cancer (LACC) patients after concurrent chemoradiotherapy (CCRT).

A total of 189 patients with LACC who received definitive CCRT between May 2018 and December 2020 and underwent MRI, including diffusion-weighted imaging, before and 1 month after initial therapy were recruited for this study. The tumor size and mean apparent diffusion coefficient (ADC_mean) were evaluated. A Cox proportional hazards model and univariate and multivariate analyses were used to determine the associations of clinical characteristics and imaging factors with progression-free survival (PFS) and overall survival (OS).

The median follow-up time was 58 (range: 11-71) months. The 5-year PFS and OS rates were 73.8% and 85.5%, respectively. Univariate analysis revealed that the serum squamous cell carcinoma (SCC) antigen level, tumor stage, pretreatment tumor size, residual disease (RD) and post-treament ADC_mean were significant predictors of PFS and OS. Positive pelvic lymph node status and adjuvant chemotherapy use after CCRT were unfavorable predictive factors in terms of PFS and OS, respectively. Multivariate analysis revealed that tumor stage, SCC antigen level, and RD were independent predictors of PFS (hazard ratio [HR] = 3.282, P < 0.001; HR = 2.567, P = 0.002; and HR = 1.621, P < 0.001, respectively) and OS (HR = 2.517, P = 0.043; HR = 1.025, P = 0.015; and HR = 1.712, P = 0.008, respectively). When patients were grouped based on the cutoff values for these markers, RD size ≥ 1.1 cm was found to indicate considerably worse PFS and OS.

Elevated SCC antigen levels, advanced tumor stage, and RD size ≥ 1.1 cm were linked to worse PFS and OS. Furthermore, the ADC_mean was not a reliable predictor of survival outcomes.