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Original research
Utilization and outcomes of adjuvant systemic chemotherapy alone in high risk, early stage cervical cancer in the United States
  1. Koji Matsuo1,
  2. David J Nusbaum2,
  3. Shinya Matsuzaki1,
  4. Maximilian Klar3,
  5. Muneaki Shimada4,
  6. Munetaka Takekuma5 and
  7. Lynda D Roman1
  1. 1 Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
  2. 2 Section of Urology, University of Chicago Medicine, Chicago, Illinois, USA
  3. 3 Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany
  4. 4 Department of Obstetrics and Gynecology, Tohoku University, Sendai, Miyagi, Japan
  5. 5 Department of Gynecologic Oncology, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka, Japan
  1. Correspondence to Dr Koji Matsuo, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 90089, USA; koji.matsuo{at}med.usc.edu

Abstract

Objective To examine trends and outcomes related to adjuvant systemic chemotherapy alone for high risk, early stage cervical cancer.

Methods This retrospective observational study queried the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program from 2000 to 2016. Surgically treated women with American Joint Commission on Cancer stages T1–2 cervical cancer who had high risk factors (nodal metastasis and/or parametrial invasion) and received additional therapy were examined. Propensity score inverse probability of treatment weighting was used to assess the survival estimates for systemic chemotherapy versus external beam radiotherapy with chemotherapy.

Results Among 2462 patients with high risk factors, 185 (7.5%) received systemic chemotherapy without external beam radiotherapy, of which the utilization significantly increased over time in multivariable analysis (adjusted odds ratio per 1 year increment 1.06, 95% confidence interval (CI) 1.02 to 1.09). In weighted models, adjuvant chemotherapy and combination therapy (external beam radiotherapy and chemotherapy) had comparable overall survival among patients aged <40 years (hazard ratio (HR) 0.73, 95% CI 0.41 to 1.33), in adenocarcinoma or adenosquamous histologies (HR 0.90, 95% CI 0.62 to 1.32), and in those with nodal metastasis alone without parametrial tumor invasion (HR 1.17, 95% CI 0.84 to 1.62). In contrast, systemic chemotherapy alone was associated with increased all cause mortality compared with combination therapy in patients aged ≥40 years (HR 1.57, 95% CI 1.19 to 2.06), with squamous histology (HR 1.63, 95% CI 1.19 to 2.22), and with parametrial invasion alone (HR 1.87, 95% CI 1.09 to 3.20) or parametrial invasion with nodal metastasis (HR 1.64, 95% CI 1.06 to 2.52).

Conclusion Utilization of adjuvant systemic chemotherapy alone for high risk, early stage cervical cancer is increasing in the United States in the recent years. Our study suggests that survival effects of adjuvant systemic chemotherapy may vary based on patient and tumor factors. External beam radiotherapy with chemotherapy remains the standard for high risk, early stage cervical cancer, and use of adjuvant systemic chemotherapy without external beam radiotherapy should be considered with caution.

  • cervical cancer

Data availability statement

The data that support the findings of this study are openly available in The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program at http://seer.cancer.gov/

https://doi.org/10.1136/ijgc-2021-002655

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    Data availability statement

    The data that support the findings of this study are openly available in The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program at http://seer.cancer.gov/

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    Footnotes

    • Contributors Conceptualization: MT and KM. Data curation: KM. Formal analysis: KM. Funding acquisition: KM and LDR. Investigation: all authors. Methodology: KM. Project administration: KM. Resources: KM and DJN. Software: KM and DJN. Supervision: KM and LDR. Validation: KM. Visualization: KM. Writing-original draft: KM. Writing-review and editing: all authors.

    • Funding Ensign Endowment for Gynecologic Cancer Research (KM).

    • Disclaimer The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    • Competing interests Consultant, Quantgene (LDR); honorarium, Chugai (KM); research grant, Merck (SM) (all outside this work).

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.