Intermediate-risk grouping of cervical cancer patients treated with radical hysterectomy: a Korean Gynecologic Oncology Group study.

Abstract

BACKGROUND: In this study, we sought to identify a criterion for the

intermediate-risk grouping of patients with cervical cancer who exhibit any

intermediate-risk factor after radical hysterectomy. METHODS: In total, 2158

patients with pathologically proven stage IB-IIA cervical cancer with any

intermediate-risk factor after radical hysterectomy were randomly assigned to two

groups, a development group and a validation group, at a ratio of 3 : 1 (1620

patients:538 patients). To predict recurrence, multivariate models were developed

using the development group. The ability of the models to discriminate between

groups was validated using the log-rank test and receiver operating

characteristic (ROC) analysis. RESULTS: Four factors (histology, tumour size,

deep stromal invasion (DSI), and lymphovascular space involvement (LVSI)) were

significantly associated with disease recurrence and included in the models.

Among the nine possible combinations of the four variables, models consisting of

any two of the four intermediate-risk factors (tumour size >/=3 cm, DSI of the

outer third of the cervix, LVSI, and adenocarcinoma or adenosquamous carcinoma

histology) demonstrated the best performance for predicting recurrence.

CONCLUSION: This study identified a 'four-factor model' in which the presence of

any two factors may be useful for predicting recurrence in patients with cervical

cancer treated with radical hysterectomy.