Radical hysterectomy without adjuvant radiotherapy in patients with cervix carcinoma FIGO 2009 IB1, with or without positive Sedlis criteria.

Lymphovascular space invasion (LVSI), deep (>1/3) stromal invasion (DSI) and large tumor size (>4 cm) have been identified as predictors for intermediate risk for recurrence according to Sedlis (at least two of the prior risk factors) in FIGO stage I cervical cancer. Adjuvant radiotherapy (RT) has been advocated in these patients(1,2), but remains controversial. All consecutive patients (1997-2017) with cervical cancer FIGO (2009) stage IB1 (≤4 cm) were included. Primary aim was to analyze the recurrence rate. Secondary aim was to identify the risk factors for disease recurrence and survival. One-hundred-and-eighty-two patients were included in this retrospective study. Median follow-up was 13 years (range 8-17). Postoperatively, 21 patients received adjuvant therapy due to presence of positive lymph nodes, positive section margins or if a simple hysterectomy was performed (RT: n = 7, concomitant chemo radiotherapy (CCRT): n = 14). None of the patients with a combination of intermediate risk factors according to Sedlis (excluding patients >4 cm) underwent adjuvant RT/CCRT. Disease recurrence was observed in 19 patients (10%). Eleven patients died of disease. LVSI influenced progression-free survival (PFS) (HR 3.950, p = 0.0163) and disease-specific survival (DSS) (HR 4.637, p = 0.0497) significantly. However, the combination of LVSI, tumor size and DSI according to Sedlis did not influence overall survival (OS), DSS or PFS. Recurrence rate was low (10%), despite the fact that patients with intermediate risk factors according to Sedlis did not receive postoperative RT/CCRT. LVSI was the sole risk factor influencing PFS and DSS. Combinations of risk factors according to Sedlis did not predict worse outcome.

Informations de copyright

Copyright © 2021 Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest I. Vergote reports grants and other from Amgen (Europe) GmbH (2019), personal fees and other from AstraZeneca (2019–2022), other from Clovis Oncology Inc. (2019–2019), other from Carrick Therapeutics (2019), other from Deciphera Pharmaceuticals (2020), from Elevar Therapeutics (2020), personal fees and other from F. Hoffmann-La Roche Ltd. (2019–2021), other from Genmab (2019–2020), personal fees and other from GSK (2019–2021), personal fees and other from Immunogen Inc. (2019–2022), personal fees from Jazzpharma (2021−2022), personal fees from Mersana (2020), other from Millennium Pharmaceuticals (2019), personal fees and other from MSD (2019–2022), personal fees and other from Novocure (2020−2022), other from Octimet Oncology NV (2019), personal fees and other from Oncoinvent AS (2019–2022), personal fees and other from Sotio a.s. (2019–2022), other from Verastem Oncology (2020), personal fees from Zentalis (2020), grants from Roche (2019–2020), outside the submitted work; and Accommodations, travel expenses from: Amgen, MSD, Roche, AstraZeneca, Tesaro. All other authors declared no conflicts of interest.