scholarly journals Survival outcomes of low-risk and intermediate-risk stage IB1 cervical cancer patients

2019 ◽  
Vol 13 (1) ◽  
pp. 27-32
Author(s):  
Asama Vanichtantikul ◽  
Patou Tantbirojn ◽  
Tarinee Manchana
Keyword(s):  
Cervical Cancer ◽  
High Risk ◽  
Prognostic Factor ◽  
Cancer Patients ◽  
Early Stage ◽  
Low Risk ◽  
Survival Outcomes ◽  
Intermediate Risk ◽  
Early Stage Cervical Cancer ◽  
Risk Patients

Abstract Background Survival for patients with early stage cervical cancer without any high-risk factors treated with radical hysterectomy is excellent. However, there are few data on the survival outcomes for low-risk and intermediate-risk early stage cervical cancer patients. Objective To determine survival outcomes and prognostic factors of low-risk and intermediate-risk stage IB1 cervical cancer patients. Methods Stage IB1 cervical cancer patients with radical hysterectomy and pelvic lymphadenectomy were retrospectively reviewed. Patients with positive pelvic nodes, parametrial involvement, and positive margin who are classified as high-risk patients were excluded. Patients with squamous cell carcinoma or grade 1–2 adenocarcinoma, tumor size less than 2 cm, no lymphovascular space invasion (LVSI), and depth of stromal invasion (DSI) less than 10 mm were defined as low-risk patients. Survival was evaluated using the Kaplan–Meier method and compared by the log-rank test. Multivariate analysis was performed using Cox proportional-hazards regression. Results There were 82 (42.3%) low-risk patients and 112 (57.7%) intermediate-risk patients. More patients in intermediate risk received adjuvant treatment (3.6% and 14.3%, P = 0.07). Three (3.6%) low-risk patients and 18 (16.1%) intermediate-risk patients had recurrent disease (P = 0.004). At median follow-up of 86 months, 1.2% of low-risk patients and 8.9% of intermediate-risk had cancer-related deaths (P = 0.02). Low-risk patients had significantly better 5-year disease-free survival (98.2% vs 91.1%, P = 0.01) and estimated 5-year overall survival (98.5% vs 91.1%, P = 0.01). DSI more than 10 mm and presence of LVSI were significantly associated with recurrence. However, LVSI was an independent prognostic factor. Conclusion Stage IB1 cervical cancer patients had excellent survival. Low-risk patients had significantly better survival. Presence of LVSI was an independent prognostic factor.

Assessing a prognostic model for predicting VTE occurrence in cancer patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1577-1577
Author(s):  
Deesha Sarma ◽  
So Yeon Kim ◽  
David H. Henry
Keyword(s):  
High Risk ◽  
Cancer Patients ◽  
Risk Group ◽  
Low Risk ◽  
Risk Category ◽  
Valuable Insight ◽  
Intermediate Risk ◽  
High Risk Patients ◽  
Prophylactic Measures ◽  
Risk Patients

1577 Background: Venous thromboembolism (VTE) poses a significant health risk to cancer patients and is one of the leading causes of death among this population. The most effective way to prevent VTE and reduce its prominence as a public health burden is by identifying high-risk patients and administering prophylactic measures. In 2008, Khorana et al. developed a model that classified patients by risk based on clinical factors. Methods: We conducted a retrospective study to test this model’s efficacy, on 150 patients with cancer receiving chemotherapy at an outpatient oncology clinic between January 1 and August 1, 2011. We aggregated data and assigned points based on the five factors in the Khorana model: site of cancer with 2 points for very high-risk site and 1 point for high-risk site, 1 point each for leukocyte counts more than 11 x 109/L, platelet counts greater than 350 X 109/L, hemoglobin levels less than 100 g/L and/or the use of erythropoiesis-stimulating agents, and BMI greater than 35 kg/m2 (Khorana et al., Blood 2008). Based on this scoring system, patients with 0 points were grouped into the low-risk category, those with 1-2 points were considered intermediate-risk, and those with 3-4 points were classified as high-risk. Results: As shown in the table, VTE incidence for the low-risk group was 1.9%, intermediate-risk group was 3.9%, and high-risk group was 9.1%. Conclusions: High-risk patients were about 4.5 times more likely to develop a VTE than low risk patients. These results provide valuable insight in determining which patients might benefit from prophylaxis and in motivating the design of prospective clinical trials that assess the VTE predictive model in various ambulatory cancer settings. [Table: see text]

Post-operative small pelvic intensity-modulated radiation therapy for early-stage cervical cancer with intermediate-risk factors: efficacy and toxicity

2021 ◽  
Author(s):  
Guangyu Zhang ◽  
Fangfang He ◽  
Li Miao ◽  
Haijian Wu ◽  
Youzhong Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Cancer Patients ◽  
Early Stage ◽  
Intensity Modulated Radiotherapy ◽  
Disease Free Survival ◽  
Intermediate Risk ◽  
Intensity Modulated ◽  
Early Stage Cervical Cancer

Abstract Objective The aim of the present study was to retrospectively evaluate the toxicity and efficacy of post-operative small pelvic intensity-modulated radiotherapy in early-stage cervical cancer patients with intermediate-risk factors. Methods Between 2012 and 2016, 151 patients who had cervical cancer (International Federation of Gynecology and Obstetrics stage I–IIA) with intermediate-risk factors were treated with post-operative small pelvic intensity-modulated radiotherapy. The median dose of 50.4 Gy in 28 fractions with small pelvic intensity-modulated radiotherapy was prescribed to the planning target volume. The intensity-modulated radiotherapy technique used was conventional fixed-field intensity-modulated radiotherapy or helical tomotherapy. Results The median follow-up was 37 months. The 3-year disease-free survival and overall survival rates were 89 and 96%, respectively. A total of 144 patients (95.3%) were alive at the last follow-up. In total, 6 patients (3.9%) had recurrence: locoregional recurrence in 3 patients (2%), distant metastasis in 2 (1.3%), and both in 1 (0.6%). Diarrhoea was the most common acute toxicity. There were no patients suffering from acute or late grade ≥ 3 toxicity. Only 4 patients (2.6%) had late grade 2 toxicities. Conclusions For early-stage cervical cancer patients with intermediate-risk factors, post-operative small pelvic intensity-modulated radiotherapy was safe and well tolerated. The rates of acute and late toxicities were quite satisfactory.

Venous Thromboembolism (VTE) and Survival in a Cancer Chemotherapy Outpatient Clinic: A Retrospective Chart Review Validation of a VTE Predictive Model.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2503-2503 ◽  
Author(s):  
Julia C. Kearney ◽  
Suzanne Rossi ◽  
Keren Glinert ◽  
David H. Henry
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Mortality Rate ◽  
Predictive Model ◽  
Cancer Patients ◽  
Low Risk ◽  
Intermediate Risk ◽  
Clinical Model ◽  
Risk Patients ◽  
Overall Mortality

Abstract Abstract 2503 Poster Board II-480 Because venous thromboembolism (VTE) often occurs as a complication of cancer and chemotherapy, cancer patients have a 47-fold elevation of risk of VTE compared to the general population (Khorana et al., Journal of Thrombosis and Haemostasis 2007). However, until recently there was not a model to accurately predict which cancer patients would experience a VTE during their treatment. Khorana et al. have developed such a model (Khorana et al., Blood 2008). We conducted a retrospective study to test the effectiveness of Khorana and colleagues' clinical model at predicting risk of VTE in patients with metastatic cancer. We collected data from an outpatient oncology clinic for 112 patients with solid tumors or malignant lymphoma who had undergone active chemotherapy in the last two years. The data included the five predictive variables outlined in Khorana et al.'s model: site of cancer (2 points for a very high-risk site, 1 point for a high-risk site); a platelet count of 350 × 109/L or more; hemoglobin less than 100g/L and or/use of erythropoiesis-stimulating agents; leukocyte count more than 11 × 109/L; and body mass index of 35kg/m2 or more (1 point each) (Khorana et al., Blood 2008). All data was collected on the first day of chemotherapy or the most recent labs before the start of chemotherapy. A score of 0 points represented a low risk of VTE, 1-2 points represented an intermediate risk and 3-4 points represented a high risk. There were 20 low risk patients, 63 intermediate risk and 29 high risk. We found that the clinical model accurately predicted which patients would experience a VTE (Table 1). Of the total 112 patients, 23 experienced a VTE. We determined that patients considered high risk were 8-fold more likely to experience a VTE as compared to low risk patients (see Table 1). Kuderer et al. demonstrated that this risk model also predicts overall mortality for patients receiving chemotherapy (Kuderer et al., ASH 2009). The results of our study also showed a strong correlation between overall mortality and a higher risk score. The mortality rate of high risk patients during the trial period was 69.0% compared to 30.0% of low risk patients and 42.9% of intermediate risk patients. Our retrospective review validates Khorana and colleagues' clinical model to predict VTE and survival rates in cancer patients. Our results, combined with data from previous studies, indicate that patients who are at risk for VTE also have a higher mortality rate. With an accurate predictive model, primary prophylaxis treatment for VTE could be considered for high risk patients. Disclosures: No relevant conflicts of interest to declare.

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