Predictors of distant metastasis or local recurrent after radiotherapy in patients with cervical cancer.

Objective: To evaluate risk factors for survival, recurrence and metastasis in patients with FIGO stage IA-IVA cervical cancer who underwent radical radiotherapy (RT) or concurrent chemoradiotherapy (CCRT).

Methods: We performed a retrospective analysis of 1288 cervical cancer patients. Kaplan-Meier curves, Cox regression models, and log-rank tests were used for statistical analysis.

Results: The 5-year overall survival rate for patients with stage I-II and stage III-IVA are 81.1% and 70.4%. In multivariable analysis, pathological type, 2009 FIGO stage, pre-treatment SCC-Ag level, pre-brachytherapy tumor size, and CCRT are independent influencing factors for patient OS. Patients with non-squamous cell carcinoma are more likely to occur distant metastasis compared to those with squamous cell carcinoma. No significant correlation was observed between histological types among patients with local recurrence. In patients with squamous cell carcinoma, multivariable analysis showed that SCC value > 11.75 at diagnosis was an independent predictor of distant metastasis and local recurrence (P = 0.001 and P = 0.038, respectively). Lymph node metastasis was an independent risk factor for distant metastasis. Age, treatment time of RT, CCRT, and pre-treatment Hb classification showed no significant correlation with cervical cancer distant metastasis and local recurrence.

Conclusions: Non-squamous cell carcinoma patients may have a worse prognosis than squamous cell carcinoma patients. In patients with squamous cell carcinoma, SCC value at diagnosis, and lymph node metastasis are independent influencing factors for distant metastasis, while SCC value at diagnosis is an independent influencing factor for local recurrence.