Geburtshilfe Frauenheilkd 2020; 80(10): e195
DOI: 10.1055/s-0040-1718151
Poster
Mittwoch, 7.10.2020
Gynäkologische Onkologie II

Utility of the 3-tier grouping system for survival discriminatory ability in stage T2a cervical cancer

M Klar
1   Klinik für Frauenheilkunde und Geburtshilfe, Gynäkologische Onkologie und Gynäkologie, Freiburg, Deutschland
,
D.J Nusbaum
2   Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Southern California, Los Angeles, Vereinigte Staaten von Amerika
,
S Matsuzaki
2   Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Southern California, Los Angeles, Vereinigte Staaten von Amerika
,
H Machida
3   Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan
,
B.H Grubbs
4   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Southern California, Los Angeles, Vereinigte Staaten von Amerika
,
I Konishi
5   Department of Obstetrics and Gynecology, Kyoto Medical Center, Kyoto, Japan
,
M Mikami
3   Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan
,
L.D Roman
2   Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Southern California, Los Angeles, Vereinigte Staaten von Amerika
,
K Matsuo
2   Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Southern California, Los Angeles, Vereinigte Staaten von Amerika
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Objective The current cervical cancer staging uses a 2-tier system for stage T2a disease based on tumor size: T2a1 (≤4cm) versus T2a2 (>4cm). Given the improved survival prediction of the 3-tier grouping system by tumor size for stage IB cervical cancer under the new staging system, this study examined the utility of a tumor size-based 3-tier system in stage T2a cervical cancer.

Methods This is a population-based retrospective observational study utilizing the SEER database between 1988 and 2016. Women with stage T2a/N0-1-x/M0-x cervical cancer were grouped by tumor size: stage T2a(≤2cm), T2a(2.1-4.0cm), and T2a(>4cm). Generalized boosted model was used to determine propensity score inverse probability of treatment weighting, and survival outcome was assessed for the proposed grouping.

Results Among 2,449 cases, the most common group was T2a(>4cm) (n=1,392 [56.8 %]), followed by T2a(2.1-4cm) (n=783 [32.0 %]) and T2a(≤2cm) (n=274, [11.2 %]). A higher sub-stage was associated with lower overall survival (OS, 5-year rates: 71.5 %, 62.0 %, and 58.0 %) and cause-specific survival (82.2 %, 71.3 %, and 65.0 %) for T2a(≤2cm), T2a(2.1-4cm), and T2a(>4cm) disease, respectively (both, P< 0.001). The 3-tier grouping system remained an independent predictor for OS: T2a(≤2cm) versus T2a(2.1-4cm), hazard ratio [HR] 0.78, 95 % confidence interval [CI] 0.71-0.87, and T2a(>4cm) versus T2a(2.1-4cm), HR 1.10, 95 %CI 1.01-1.21. The 3-tier grouping system had larger survival discriminatory ability compared to the traditional 2-tier system: OS 13.5 % versus 6.7 %, and cause-specific survival 17.2 % versus 9.2 %.

Conclusion Our study suggests that a tumor size-based 3-tier grouping system may be useful for improved prediction of mortality in stage T2a cervical cancer



Publication History

Article published online:
07 October 2020

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