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  • Oncological outcome of surgical management in patients with recurrent uterine cancer—a multicenter retrospective cohort study—CEEGOG EX01 Trial

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Original Article
Oncological outcome of surgical management in patients with recurrent uterine cancer—a multicenter retrospective cohort study—CEEGOG EX01 Trial
  1. Anna Germanova1,
  2. Francesco Raspagliesi2,
  3. Luis Chiva3,
  4. Ladislav Dusek4,
  5. Macit Arvas5,
  6. Eric Leblanc6,
  7. Tibor Lengeyl7,
  8. Violante Di Donato8,
  9. Afra Zaal9,
  10. Polat Dursun10,
  11. Ignacio Zapardiel11,
  12. Taner Turan12,
  13. Sergio Augusto Triginelli13,
  14. Sang Wun Kim14,
  15. Matias Jurado15,
  16. Jalid Sehouli16,
  17. Borek Sehnal17,
  18. Ladislav Masak18,
  19. Nicolae Ioanid19,
  20. Greta Dreyer20,
  21. Robert Jach21,
  22. Miloš Mlynček22,
  23. Valentina Chiappa2,
  24. Fabio Martinelli2,
  25. Jiri Slama1,
  26. Roman Kocian1,
  27. Giorgio Bogani2 and
  28. David Cibula1
  1. 1 Department of Obstetrics and Gynecology, Gynecologic Oncology Center, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
  2. 2 Fondazione IRCCS, IstitutoNazionale dei Tumori, Milan, Italy
  3. 3 Department of Gynecologic Oncology, MD Anderson Cancer Center, Madrid, Spain
  4. 4 Institute for Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
  5. 5 Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
  6. 6 Département de Cancérologie Gynécologique, Oscar Lambret Center, Lille, France
  7. 7 Department of Gynecologic Oncology, National Cancer Institute, Bratislava, Slovakia
  8. 8 Department of Gynecology,Obstetrics and Urology, Sapienza University of Rome, Rome, Italy
  9. 9 Department of Gynecological Oncology, University Medical Center Utrecht, Utrecht, Netherlands
  10. 10 Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Baskent University Schoolof Medicine, Ankara, Turkey
  11. 11 Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
  12. 12 Division of Gynecologic Oncology, Department ofObstetrics and Gynecology, Etlik Zubeyde Hanim Womens Health Research and Teaching Hospital, Ankara, Turkey
  13. 13 Division of Women's Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
  14. 14 Department of Obstetrics and Gynecology, Institute of Women'sLife Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
  15. 15 Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
  16. 16 Department of Gynecology with Center for Oncological Surgery, European Competence Center for Ovarian Cancer, Campus Virchow Klinikum, Medical University of Berlin, Berlin, Germany
  17. 17 First Faculty of Medicine, Charles University in Prague and Hospital Na Bulovce in Prague, Prague, Czech Republic
  18. 18 St. Elizabeth Cancer Institute, Bratislava, Slovak Republic
  19. 19 First Department of Oncologic Surgery, Gynecologic Oncology Unit, Regional Institute of Oncology, Iasi, Romania
  20. 20 Department Obstetrics and Gynaecology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
  21. 21 Department of Gynecology and Obstetrics, Jagiellonian University Medical College, Krakow, Poland
  22. 22 Department of Obstetrics and Gynecology, Faculty Hospital, Constantine the Philosopher University, Nitra, Slovakia
  1. Correspondence to Dr Anna Germanova, Department of Obstetrics and Gynecology, Gynecologic Oncology Center, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague 120 18, Czech Republic; ena.german{at}gmail.com

Abstract

Objectives To assess the survival of patients who have received an operation for recurrent cervical and endometrial cancer and to determine prognostic variables for improved oncologic outcome.

Methods A retrospective multicenter analysis of the medical records of 518 patients with cervical (N = 288) or endometrial cancer (N = 230) who underwent surgery for disease recurrence and who had completed at least 1 year of follow-up.

Results The median survival reached 57 months for patients with cervical cancer and 113 months for patients with endometrial cancer after surgical treatment of recurrence (p = 0.036). Histological sub-type had a significant impact on overall survival, with the best outcome in endometrial endometrioid cancer (121 months), followed by cervical squamous cell carcinoma, cervical adenocarcinoma, or other types of endometrial cancer (81 vs 35 vs 35 months; p<0.001). The site of recurrence did not significantly influence survival in cervical or in endometrial cancer. Cancer stage at first diagnosis, tumor grade, lymph node status at recurrence, progression-free interval after first diagnosis, and free resection margins were associated with improved overall survival on univariate analysis. On multivariate analysis, the stage at first diagnosis and resection margins were significant independent predictive parameters of an improved oncologic outcome.

Conclusion Long-term survival can be achieved via secondary cytoreductive surgery in selected patients with recurrent cervical and endometrial cancer. An excellent outcome is possible even if the recurrence site is located in the lymph nodes. The possibility of achieving complete resection should be the main criterion for patient selection.

  • uterine cancer
  • secondary cytoreductive surgery

https://doi.org/10.1136/ijgc-2019-000292

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    Footnotes

    • Correction notice Since this paper was first published online, further authors have been added to this manuscript.

    • Contributors AG: data collection, data clarification, manuscript preparation. FR, LC, MA, EL, TL, VDD, AZ, PD, IZ, TT, SAT, SWK, VC, FM, JS, GB, RK: data collection, participation in manuscript preparation. LD: statistical analyses, participation in manuscript preparation. DC: author of study design, consultant, manuscript preparation.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.