Survival Outcomes and Prognostic Factors for Patients in Early Stage Cervical Cancer: A Multicentric Study in Turkey

TL;DR

This study analyzed survival outcomes in early-stage cervical cancer patients in Turkey and found that lymph node metastasis is a key factor affecting survival.

Contribution

The study provides new insights into prognostic factors for early-stage cervical cancer in a large Turkish multicenter cohort.

Findings

Lymph node metastasis was identified as an independent prognostic factor for both disease-free and overall survival.

The 5-year overall survival rate was 98.4%, and the 5-year disease-free survival rate was 85.3%.

Tailored adjuvant treatment strategies are emphasized based on nodal status, stromal invasion, margin status, and LVSI.

Abstract

Background: To identify prognostic factors related to survival in patients with early-stage cervical cancer treated with radical surgery in six high-volume gynecologic oncology centers in Turkey. Methods: This retrospective analysis examined a cohort of 612 patients diagnosed with cervical cancer who underwent type II/III radical hysterectomy and pelvic lymphadenectomy, with or without para-aortic lymphadenectomy at six gynecologic oncology centers. A total of 537 patients between 1993 and 2023 were included. According to the 2009 FIGO staging system, 411 patients (76.5%) were stage IB1, 76 (14.2%) were stage IB2, 40 (4.7%) were stage IIA1, and 10 (1.9%) were stage IIA2. Patients underwent either type II or type III radical hysterectomy with pelvic lymphadenectomy, with para-aortic lymphadenectomy performed in 93.1% of cases. Among the 537 patients, 258 (48%) underwent type II radical hysterectomy and 279 (52%) underwent type III. Univariate and multivariate analyses of 5-year overall survival (OS) and 5-year disease-free survival (DFS) were performed. Results: In the entire cohort, 258 (48%) patients underwent radical surgery alone, while 279 (52%) patients underwent radical surgery followed by adjuvant therapy. The 5-year DFS and 5-year OS rates were 85.3% and 98.4%, respectively. In the multivariate logistic analysis, lymph node metastasis was identified as an independent prognostic factor for DFS and OS. Conclusions: Lymph node metastasis was the most important prognostic factor for survival in this large multicenter Turkish cohort. These findings highlight the prognostic value of nodal status, stromal invasion, margin status, and LVSI, while underscoring the importance of tailored adjuvant treatment strategies.

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