Comparative Analysis of Oncologic Outcomes in Patients with Squamous Cell Carcinoma of the Uterine Cervix with High-Risk Features for Para-Aortic Recurrence: Prophylactic Extended-Field versus Pelvic Chemoradiotherapy

Figures & data

Table 1 Patient Characteristics (n =115)

Parameters	WPRT	EFRT	p value
Age (years)			0.094
< 55	37 (42.5%)	17 (60.7%)
≥ 55	50 (57.5%)	11 (39.3%)
Diabetes mellitus			0.999
No	79 (90.8%)	26 (92.9%)
Yes	8 (9.2%)	2 (7.1%)
Hypertension			0.722
No	71 (81.6%)	22 (78.6%)
Yes	16 (18.4%)	6 (21.4%)
MRI staging			<0.001
No	61 (70.1%)	5 (17.9%)
Yes	26 (29.9%)	23 (82.1%)
FIGO stage 2009			0.090
I	9 (10.3%)	4 (14.3%)
II	44 (50.6%)	18 (64.3%)
III	30 (34.5%)	6 (21.4%)
IV	4 (4.6%)	0 (0%)
FIGO stage 2018			0.110
I	5 (5.7%)	1 (3.6%)
II	29 (33.3%)	3 (10.7%)
III	49 (56.3%)	24 (85.7%)
IV	4 (4.6%)	0 (0.0%)
PM score			0.016*
0–3	46 (52.9%)	22 (78.6%)
4–6	41 (47.1%)	6 (21.4%)
Pelvic LN			<0.001*
Negative	57 (65.5%)	4 (14.3%)
Positive	30 (34.5%)	24 (85.7%)
SCC-Ag (ng/mL)			0.524
< 20	59 (67.8%)	18 (64.3%)
20~39.99	18 (20.7%)	5 (17.9%)
≥ 40	10 (11.5%)	5 (17.9%)
CEA (ng/mL)			0.191
< 10	71 (81.6%)	20 (71.4%)
≥ 10	14 (16.1%)	8 (28.6%)
Unknown	2 (2.3%)	0 (0%)
Risk group			0.074
Intermediate	54 (62.1%)	12 (42.9%)
High	33 (37.9%)	16 (57.1%)

Note: *Statistically significant.

Abbreviations: WPRT, whole-pelvis radiotherapy; EFRT, extended-field chemoradiotherapy; LN, lymph node; SCC-Ag, squamous cell carcinoma antigen; CEA, carcinoembryonic antigen.

Figure 1 Overall survival in the EFRT and WPRT groups. Patients treated with EFRT had significantly better overall survival.

Figure 2 Pelvic recurrence rate in the EFRT and WPRT groups. The pelvic recurrence rate was not significantly different between the two groups.

Figure 3 Extrapelvic recurrence rate in the EFRT and WPRT groups. Patients treated with EFRT have less extrapelvic recurrence.

Figure 4 PALN recurrence rate in the EFRT and WPRT groups. EFRT significantly reduced the PALN recurrence rate.

Table 2 Comparison of Treatment Outcomes Between FIGO 2018 IIIC1 Patients and Non-IIIC1 Patients

Outcomes	WPRT	EFRT	p value
FIGO 2018 IIIC1
5-year OS	55.5%	100.0%	0.287
5-year pelvic recurrence	13.8%	8.5%	0.501
5-year EP recurrence	47.9%	13.8%	0.016*
5-year PALN recurrence	33.3%	0.0%	0.007*
FIGO 2018 Non-IIIC1
5-year OS	71.4%	85.7%	0.155
5-year pelvic recurrence	31.1%	25.0%	0.852
5-year EP recurrence	44.5%	33.3%	0.474
5-year PALN recurrence	28.5%	0.0%	0.318

Note: *Statistically Significant.

Abbreviations: WPRT, whole-pelvic radiotherapy; EFRT, extended-field radiotherapy; OS, overall survival; LR, locoregional; EP, extrapelvic; PALN, para-aortic lymph node.

Table 3 Treatment Outcomes Between Patients with and without MRI Staging

Outcomes	WPRT	EFRT	p value
MRI
5-year OS	80.6%	94.1%	0.128
5-year pelvic recurrence	19.6%	8.9%	0.311
5-year EP recurrence	34.6%	18.0%	0.130
5-year PALN recurrence	18.6%	0.0%	0.053
No MRI
5-year OS	53.0%	60.0%	0.777
5-year pelvic recurrence	27.8%	20.0%	0.706
5-year EP recurrence	50.7%	20.0%	0.356
5-year PALN recurrence	35.7%	0.0%	0.230

Abbreviations: WPRT, whole-pelvic radiotherapy; EFRT, extended-field radiotherapy; OS, overall survival; LR, locoregional; EP, extrapelvic; PALN, para-aortic lymph node.

Table 4 Multivariate Analysis of OS and EPR

Parameters	OS		EPR
	HR (95% CI)	p value	HR (95% CI)	p value
Age
< 55	Reference		Reference
≥ 55	0.612 (0.305–1.231)	0.169	0.628 (0.318–1.239)	0.179
FIGO 2018		0.002*		0.002*
I	Reference		Reference
II	2.198 (0.284–17.015)	0.451	1.231 (0.268–5.651)	0.789
III	1.568 (0.206–11.948)	0.664	1.032 (0.234–4.562)	0.967
IV	16.781 (1.748–161.123)	0.015*	15.016 (2.133–105.726)	0.007*
Risk group
Intermediate	Reference		Reference
High	1.494 (0.768–2.907)	0.237	1.164 (0.589–2.301)	0.663
EFRT
No	Reference		Reference
Yes	0.276 (0.081–0.937)	0.039*	0.286 (0.097–0.838)	0.023*

Note: *Statistically significant.

Abbreviations: OS, overall survival; EPR, extrapelvic recurrence.