Elsevier

Gynecologic Oncology

Volume 78, Issue 2, August 2000, Pages 187-193
Gynecologic Oncology

Regular Article
Posttherapy Surveillance of Women with Cervical Cancer: An Outcomes Analysis

https://doi.org/10.1006/gyno.2000.5860Get rights and content

Abstract

Objective. The aim of this study was to develop a surveillance program that optimizes clinical outcome following primary treatment of women with cervical cancer.

Methods. The records of 1096 patients with FIGO stage IB cervical cancer treated from 1983 to 1993 were retrospectively reviewed. Recurrence was analyzed by site, presence or absence of symptoms, method of detection, and survival. Univariate and multivariate analyses using a Cox proportional hazards model were performed.

Results. One hundred thirty-three patients (13%) developed recurrent disease. Of these, 114 were symptomatic and 19 were asymptomatic at the time of recurrence. Thirty-seven patients recurred in the central pelvis, 21 each in the lung or pelvic wall, 22 in nodes, and 35 in other sites. The median disease-free interval was 17 months for symptomatic patients and 16 months for asymptomatic patients. The median survival from initial diagnosis was 31 months for symptomatic and 83 months for asymptomatic patients (P = 0.001). The median survival from recurrence was 11 months for symptomatic and 42 months for asymptomatic patients (P < 0.001). Multivariate analysis revealed that symptom status at time of recurrence was a significant predictor of survival, even when known prognostic factors were considered (P < 0.001). All asymptomatic pelvic recurrences were diagnosed by pelvic exam; all asymptomatic pulmonary recurrences were detected by chest radiographs. Pap smears did not detect a single asymptomatic recurrence.

Conclusions. Posttherapy surveillance programs are directed toward asymptomatic patients in whom early detection of recurrence may impact survival. These data indicate that a subset of women may benefit from surveillance. A model for surveillance is proposed.

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Presented at the 28th Annual Meeting of the Society of Gynecologic Oncologists, Phoenix, AZ, March 22–26, 1997.

1

To whom reprint requests should be addressed at Department of Gynecologic Oncology, Box 67, 1515 Holcombe Blvd., Houston, TX, 77030. Fax: (713) 792-7586. E-mail: [email protected].

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