Objective To demonstrate whether radiotherapy has an effect on the survival of patients with stage IVb (M1) cervical cancer, as it has not been adequately clarified.
Methods We analyzed International Federation of Gynecology and Obstetrics (FIGO) stage M1 cervical cancer diagnosed in patients between 1992 and 2013 using population-based data from the Surveillance, Epidemiology, and End Results registry. Propensity score (PS) analysis with 1:1 matching and the nearest neighbor matching method was performed to ensure well-balanced characteristics of comparison groups. Data were analyzed by Kaplan-Meier and Cox proportional hazards regression models to evaluate the overall survival (OS) and cancer-specific survival (CSS) months with corresponding 95% confidence intervals (95% CIs).
Results In general, receiving radiotherapy significantly improved OS and CSS both before and after PS matching (PSM) (P < 0.001), with significantly improved OS (hazard ratio, 0.69; 95% CI, 0.62-0.76) and CSS (hazard ratio, 0.79; 95% CI, 0.70-0.89) after PSM in patients with stage M1 cervical cancer. Before PSM, radiotherapy was found to be associated with improved survival even for the patients with stage M1 cervical cancer with extensive metastasis (≥2 metastatic sites) (P < 0.001). Although P value was not significant for brain metastasis, the survival month was numerically improved before PSM (OS and CSS, 1 month vs 4 months). Overall, radiotherapy still significantly improved survival for patients with one metastatic site (ie, oligometastases) either before or after PSM (P < 0.05), with the survival month improved more than 6 months.
Conclusions The large Surveillance, Epidemiology, and End Results results support that radiotherapy might improve the survival of patients with metastatic cervical cancer. It might be prudent to carefully select suitable patients for radiation therapy for metastatic cervical cancer.
- Cervical cancer
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Kejie Huang and Mingfang Jia contributed equally to this work.
Author contributions: Zhenming Fu and Mingfang Jia designed and directed the study. Kejie Huang, Mingfang Jia, and Zhenming Fu analyzed the data. Kejie Huang, Mingfang Jia, Jianglong Han, Rui Zhang, and Zhenming Fu drafted the manuscript. Qibin Song and Zhenming Fu supervised the study. Ping Li, Yunfeng Qiao, and Qin Li helped with the statistical analysis and data cleaning. Qibin Song, Tangpeng Xu, and Peng Ruan provided clinical insights and did the literature review and helped with the drafting of the manuscript. All authors reviewed and approved the final draft. This article is not under consideration elsewhere.
This study was supported by grants 81472971 and 81773555 from the National Science Foundation of China (NSFC). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NSFC.
The authors declare no conflicts of interest.
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