Effect of Cisplatin Cycles on Prognosis for Cervical Cancer Patients Treated With Concurrent Chemoradiotherapy: A...

IntroductionTo assess the impact of cisplatin cycles on overall survival (OS) and disease-free survival (DFS) in cervical cancer (CC) patients undergoing concurrent chemoradiotherapy (CCRT), and to build a nomogram-based prognostic stratification to identify CC patients who might benefit from ≥ 5 cycles of cisplatin.MethodsThis study retrospectively analyzed data from 918 patients who were treated with external beam radiotherapy and brachytherapy. Weekly cisplatin was the concurrent regimen. The difference in survival outcomes between the < 5 cycles and ≥ 5 cycles groups were compared. Subgroup analysis was further conducted. Univariate and multivariate Cox regression analyses were performed in the <5 cycles, and a nomogram was developed accordingly. The patients were divided into two risk subgroups and the survival outcomes were compared.ResultsThe 5-year OS and DFS were 76.7% and 86.1% (p = 0.002), 68.7% and 78.3% (p = 0.0016) for the < 5 and ≥ 5 cycles, respectively. In subgroup analysis, the survival benefit of ≥ 5 cycles could be maintained in patients with > 50 years old, squamous disease, squamous cell carcinoma antigen (SCC Ag) > 1.5 ng/mL, tumor size > 4 cm, International Federation of Gynecology and Obstetrics (FIGO) stage I/II, and no para-aortic metastatic lymph nodes, whereas no significant benefit was observed in FIGO stage III/IV. A nomogram incorporating size, SCC Ag, and stage was constructed, and patients were divided into two risk groups (low-risk and high-risk). Receiving ≥ 5 cycles showed superiority in OS (p = 0.0025) and DFS (p = 0.008) over < 5 cycles in the low-risk subgroup.ConclusionReceiving ≥ 5 cycles of cisplatin was associated with OS and DFS in patients with CC who received CCRT. A nomogram was constructed and the newly defined low-risk patients might gain significant OS and DFS benefit from receiving ≥ 5 cycles.