Effect of the surgical approach on survival outcomes in patients undergoing radical hysterectomy for cervical cancer: A real‐world multicenter study of a large Chinese cohort from 2006 to 2017

We purposed to develop machine learning models predicting survival outcomes according to the surgical approach for radical hysterectomy (RH) in early cervical cancer. In total, 1056 patients with 2009 FIGO stage IB cervical cancer who underwent primary type C RH by either open or laparoscopic surgery were included in this multicenter retrospective study. The whole dataset consisting of patients’ clinicopathologic data was split into training and test sets with a 4:1 ratio. Using the training set, we developed models predicting the probability of 5-year progression-free survival (PFS) and overall survival (OS) with tenfold cross validation. The developed models were validated in the test set. In terms of predictive performance, we measured the area under the receiver operating characteristic curve (AUC) values. The logistic regression models comprised of preoperative variables yielded AUCs of 0.679 and 0.715 for predicting 5-year PFS and OS rates, respectively. Combining both logistic regression and multiple machine learning models, we constructed hybrid ensemble models, and these models showed much improved predictive performance, with 0.741 and 0.759 AUCs for predicting 5-year PFS and OS rates, respectively. We successfully developed models predicting disease recurrence and mortality after primary RH in patients with early cervical cancer. As the predicted value is calculated based on the preoperative factors, such as the surgical approach, these ensemble models would be useful for making decisions when choosing between open or laparoscopic RH.

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Efficacy of different surgical approaches on survival outcomes in patients with early-stage cervical cancer: protocol for a multicentre longitudinal study in China

BMJ Open ◽

10.1136/bmjopen-2020-038020 ◽

2020 ◽

Vol 10 (8) ◽

pp. e038020

Author(s):

Xiaopei Chao ◽

Ming Wu ◽

Shuiqing Ma ◽

Xianjie Tan ◽

Sen Zhong ◽

...

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Early Stage ◽

Disease Free Survival ◽

Learning Curves ◽

Surgical Approaches ◽

Survival Outcomes ◽

Link Type ◽

Gynecology And Obstetrics ◽

Early Stage Cervical Cancer

IntroductionRecent studies have revealed that the oncological survival outcomes of minimally invasive radical hysterectomy (MIRH) are inferior to those of abdominal radical hysterectomy (ARH) in early-stage cervical cancer, but the potential reasons are unclear.Methods and analysisEach expert from 28 study centres participating in a previously reported randomised controlled trial (NCT03739944) will provide successive eligible records of at least 100 patients who accepted radical hysterectomy for early-stage cervical cancer between 1 January 2009 and 31 December 2015. Inclusion criteria consist of a definite pathological evaluation of stages IA1 (with positive lymphovascular space invasion), IA2 and IB1 according to the International Federation of Gynecology and Obstetrics 2009 staging system and a histological subtype of squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma. The primary endpoint is 5-year disease-free survival between the MIRH and ARH groups. The secondary endpoints include the MIRH learning curves of participating surgeons, 5-year overall survival between the MIRH and ARH groups, survival outcomes according to surgical chronology, surgical outcomes and sites of recurrence and potential risk factors that affect survival outcomes. A subgroup analysis in patients with tumour diameter less than 2 cm will follow the similar flow diagram.Ethics and disseminationThis study has been approved by the Institutional Review Board of Peking Union Medical College Hospital (registration no. JS-1711), and is also filed on record by all other 27 centres. The results will be disseminated through community events and peer-reviewed journals.Trial registration numberNCT03738969

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Robot-assisted radical hysterectomy—perioperative and survival outcomes in patients with cervical cancer compared to laparoscopic and open radical surgery

Gynecological Surgery ◽

10.1007/s10397-011-0683-7 ◽

2011 ◽

Vol 9 (1) ◽

pp. 81-88 ◽

Cited By ~ 11

Author(s):

Grigor Gortchev ◽

Slavcho Tomov ◽

Latchesar Tantchev ◽

Angelika Velkova ◽

Zdravka Radionova

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Radical Surgery ◽

Survival Outcomes ◽

Robot Assisted

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Comparison of survival outcomes of abdominal radical hysterectomy and radiochemotherapy IIA2 (FIGO2018) cervical cancer: a retrospective study from a large database of 63,926 cases of cervical cancer in China

International Journal of Clinical Oncology ◽

10.1007/s10147-021-02090-9 ◽

2021 ◽

Author(s):

Junshen He ◽

Donglin Li ◽

Ping Shen ◽

Wentong Liang ◽

Shan Kang ◽

...

Keyword(s):

Cervical Cancer ◽

Retrospective Study ◽

Radical Hysterectomy ◽

Survival Outcomes ◽

Large Database

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Survival impact of additional chemotherapy after adjuvant concurrent chemoradiation in patients with early cervical cancer who underwent radical hysterectomy

BMC Cancer ◽

10.1186/s12885-021-08940-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Se Ik Kim ◽

Jeong Yun Kim ◽

Chan Woo Wee ◽

Maria Lee ◽

Hee Seung Kim ◽

...

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Figo Stage ◽

Concurrent Chemoradiation ◽

Survival Outcomes ◽

Control Group ◽

Study Group ◽

Additional Chemotherapy ◽

Risk Patients ◽

Early Cervical Cancer

Abstract Background To determine whether additional chemotherapy after concurrent chemoradiation (CCRT) improves survival outcomes in patients with early cervical cancer who undergo radical hysterectomy (RH). Methods We included high- or intermediate-risk patients from two institutions, with 2009 FIGO stage IB–IIA, who underwent primary RH and pelvic lymphadenectomy between January 2007 and June 2020, and had completed adjuvant CCRT. Survival outcomes were compared between patients who received additional chemotherapy (study group) and those who did not (control group). Results A total of 198 patients were included in this analysis. The study (n = 61) and control groups (n = 137) had similar patient age, histologic cancer type, 2009 FIGO stage, and tumor size. However, minimally invasive surgery was performed less frequently in the study group than in the control group (19.7% vs. 46.0%, P < 0.001). The presence of pathologic risk factors was similar, except for lymph node metastasis, which was more frequent in the study group (72.1% vs. 46.0%; P = 0.001). In survival analyses, no differences in the disease-free survival (DFS; P = 0.539) and overall survival (OS; P = 0.121) were observed between the groups. Multivariate analyses adjusting for surgical approach and other factors revealed that additional chemotherapy was not associated with DFS (adjusted HR, 1.149; 95% CI, 0.552–2.391; P = 0.710) and OS (adjusted HR, 1.877; 95% CI, 0.621–5.673; P = 0.264). The recurrence patterns did not differ with additional chemotherapy. Consistent results were observed in a subset of high-risk patients (n = 139). Conclusions Additional chemotherapy after CCRT might not improve survival outcomes in patients with early cervical cancer who undergo RH.

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