Impact of sites versus number of metastases on survival of patients with organ metastasis from newly diagnosed cervical cancer

Figures & data

Table 1 Patient baseline characteristics at the time of initial diagnosis and treatment types (n=99)

Characteristics	No.%
Age (yr), median (range)	53 (29–90)
ECOG PS
0	35 (35.4)
1	16 (16.2)
2	22 (22.2)
3	20 (20.2)
4	6 (6.1)
Histological subtype
Squamous cell carcinoma	80 (80.8)
Small-cell neuroendocrine carcinoma	7 (7.1)
Adenocarcinoma	6 (6.1)
Adeno-squamous cell carcinoma	3 (3)
Undifferentiated carcinoma	2 (2)
Sarcoma	1 (1)
Primary tumor size (cm)
≥4-cm	72
<4-cm	27
Initial treatment
Chemotherapy + local treatment	49 (49.5)
Chemotherapy	15 (15.2)
Radiotherapy	11 (11.1)
Supportive care	24 (24.2)
Diagnostic methods of metastatic lesions
CT/MRI/ECT	47 (47.5)
PET-CT	31 (31.3)
Biopsy	21 (21.2)
Single organ metastasis
Bone	24 (24.2)
Lung	16 (16.2)
Liver	3 (3)
Brain	1 (1)
Spleen	1 (1)
Single organ + distant lymph node metastasis
Bone + distant lymph node	12 (21.1)
Lung + distant lymph node	10 (10.1)
Liver + distant lymph node	10 (10.1)
Two organ metastasis
Liver + lung	3 (3)
Lung + spleen	2 (2)
Liver + bone	1 (1)
Liver + kidney	1 (1)
Two organ metastasis + distant lymph node metastasis
Liver + lung + distant lymph node	6 (6.1)
Bone + lung + distant lymph node	4 (4)
Liver + bone + distant lymph node	2 (2)
Liver + adrenal gland + distant lymph node	1 (1)
Multiorgan metastasis
Liver + lung + bone + breast	1 (1)
Multiorgan + distant lymph node metastasis
Liver + lung + bone + adrenal gland + distant lymph node	1 (1)

Abbreviations: ECOG PS, Eastern Cooperative Oncology Group performance status; MRI, magnetic resonance imaging; CT, computed tomography; ECT, emission computed tomography; PET-CT, positron emission tomography-computed tomography.

Table 2 Median survival time and survival rates according to clinicopathologic factors (n=99)

Variable	No.	Median OS	Median PFS	1-year OS rates	2-year OS rates
		(Months)	(Months)	(%)	(%)
Age
≥50 years	65	11.7	6.4	47.1	24.5
<50 years	34	10.7	4.6	50	19.3
Size of the cervical tumor
≥4-cm	72	11.7	5.2	48.6	21.7
< 4-cm	27	11.6	8.1	46.9	25.8
Histological subtype
SCC	80	13.0	5.7	52.5	25.9
Non-SCC	19	8.3	3.9	29.2	8.8
ECOG PS
0-2	73	14.8	7.5	59.9	29.6
3-4	26	5.8	1.9	15.4	3.8
Oligometastasis
Yes	36	16.6	9.3	66.7	41.2
No	63	10.1	4.3	37.5	12
Bone metastasis
Yes	46	14.8	7.1	65.2	31.1
No	53	9.7	4.3	33.1	15.6
Number of organ metastasis
Single	77	13.4	6.9	55.5	27.4
Multiple	22	10.0	4.3	22.7	5.7
Lung metastasis
Yes	41	10.8	4.6	35.4	12.6
No	58	14.0	6.5	56.9	30
Liver metastasis
Yes	30	6.8	3.7	20	8
No	69	14.2	7.5	60.5	29.1
Distant lymph node metastasis
Yes	46	10.9	4.7	43.5	15.6
No	53	13.1	6.0	52.2	29
Initial treatment
Chemotherapy+local treatment	49	17.3	9.4	64.8	37
Chemotherapy	15	10.7	5.9	40	8.9
Radiotherapy	11	5.9	2.4	27.3	9.1
Supportive care	24	7.3	1.8	29.2	8.3

Abbreviations: SCC, Squamous cell carcinoma; ECOG PS, Eastern Cooperative Oncology Group performance status; OS, overall survival; PFS, progression-free survival.

Figure 1 Overall survival among patients with organ metastatic cervical cancer at diagnosis.

Notes: Kaplan-Meier curves of overall survival for (A) patients in the whole group, (B) liver metastasis vs non-liver metastasis.

Table 3 Univariate analysis of prognostic factors for progression-free survival and overall survival (n=99)

Variable	PFS		OS
HR (95% CI)	P-value	HR (95% CI)	P-value
Age
≥50 years	1		1
<50 years	1.34 (0.86–2.09)	0.198	1.26 (0.81–1.96)	0.310
Size of the cervical tumor
≥4-cm	1		1
<4-cm	0.86 (0.52–1.42)	0.541	0.86 (0.52–1.43)	0.554
Histological subtype
SCC	1		1
Non-SCC	1.39 (0.81–2.38)	0.234	1.86 (1.08–3.21)	0.026
ECOG PS
0–2	1		1
3–4	4.14 (2.52–6.79)	<0.001	3.29 (2.04–5.32)	<0.001
Oligometastasis
Yes	1		1
No	2.10 (1.32–3.35)	0.002	2.04 (1.28–3.24)	0.003
Bone metastasis
Yes	1		1
No	1.72 (1.10–2.67)	0.017	1.74 (1.13–2.70)	0.013
Number of organ metastasis
Single	1		1
Multiple	1.58 (0.95–2.62)	0.08	1.89 (1.13–3.17)	0.016
Lung metastasis
Yes	1		1
No	0.62 (0.40–0.96)	0.033	0.66 (0.43–1.02)	0.060
Liver metastasis
Yes	1		1
No	0.48 (0.30–0.76)	0.002	0.39 (0.24–0.62)	<0.001
Distant lymph node metastasis
Yes	1		1
No	0.66 (0.43–1.02)	0.061	0.65 (0.42–1.01)	0.050
Initial treatment
Supportive care	1		1
Chemotherapy + local treatment	0.27 (0.16–0.45)	<0.001	0.31 (0.18–0.53)	<0.001
Chemotherapy	0.52 (0.27–1.02)	0.056	0.74 (0.38–1.44)	0.378
Radiotherapy	1.29 (0.62–2.68)	0.499	0.98 (0.48–2.03)	0.973

Abbreviations: SCC, Squamous cell carcinoma; ECOG PS, Eastern Cooperative Oncology Group performance status; CI, confidence interval; HR, hazard ratio; OS, overall survival; PFS, progression-free survival.

Table 4 Multivariate analysis of prognostic factors for progression-free survival and overall survival (n=99)

Variable	PFS		OS
	HR (95% CI)	P-value	HR (95% CI)	P-value
Histological subtype
SCC	1		1
Non-SCC	1.30 (0.70-2.41)	0.404	1.78 (0.94-3.37)	0.077
ECOG PS
0-2	1		1
3-4	1.91 (0.88-4.14)	0.102	1.48(0.70-3.13)	0.300
Oligometastasis
Yes	1		1
No	1.39 (0.75-2.56)	0.292	1.27(0.69-2.37)	0.446
Bone metastasis
Yes	1		1
No	2.32 (0.85-6.38)	0.101	1.88(0.62-5.76)	0.268
Number of organ metastasis
Single	1		1
Multiple	2.70 (0.86-8.43)	0.088	2.01(0.57-7.03)	0.275
Lung metastasis
Yes	1		1
No	0.41 (0.15-1.12)	0.082	0.61(0.20-1.83)	0.375
Liver metastasis
Yes	3.77 (1.22-11.69)	0.021	4.02(1.15-14.05)	0.029
No	1		1
Distant lymph node metastasis
Yes	1		1
No	0.97 (0.60-1.56)	0.892	0.87(0.53-1.43)	0.575
Initial treatment
Supportive care	1		1
Chemotherapy+ local treatment	0.42 (0.20-0.91)	0.027	0.40 (0.19-0.82)	0.012
Chemotherapy	0.67 (0.28-1.58)	0.353	0.74(0.33-1.67)	0.467
Radiotherapy	1.45 (0.68-3.10)	0.341	1.21(0.54-2.72)	0.637

Abbreviations: SCC, Squamous cell carcinoma; ECOG PS, Eastern Cooperative Oncology Group performance status; CI, confidence interval; HR, hazard ratio; OS, overall survival; PFS, progression-free survival.