1. The annual recurrence risk model for tailored surveillance strategy in patients with cervical cancer
- Author
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Jaroslav Klat, Darwin Pari, Luc R.C.W. van Lonkhuijzen, Klára Benešová, Nicolò Bizzarri, Ignacio Zapardiel, Nadeem R. Abu-Rustum, Aldo Lopez, Jiří Sláma, Andreas Obermair, Fabio Landoni, Mehmet Mutlu Meydanli, Anna Fagotti, Diego Odetto, Veronika Javůrková, Sarah H. Kim, Vít Weinberger, Rosa A. Salcedo-Hernández, Jiri Jarkovsky, Henrik Falconer, Ali Ayhan, Jan Kosťun, David Cibula, L Dostalek, Constantijne H. Mom, Sahar Salehi, Juliana Rodriguez, Ranjit Manchanda, Martina Borčinová, Ricardo dos Reis, David Isla Ortiz, Rene Laky, Huseyin Akilli, Obstetrics and Gynaecology, CCA - Cancer Treatment and Quality of Life, Cibula, D, Dostalek, L, Jarkovsky, J, Mom, C, Lopez, A, Falconer, H, Fagotti, A, Ayhan, A, Kim, S, Isla Ortiz, D, Klat, J, Obermair, A, Landoni, F, Rodriguez, J, Manchanda, R, Kostun, J, dos Reis, R, Meydanli, M, Odetto, D, Laky, R, Zapardiel, I, Weinberger, V, Benesova, K, Borcinova, M, Pari, D, Salehi, S, Bizzarri, N, Akilli, H, Abu-Rustum, N, Salcedo-Hernandez, R, Javurkova, V, Slama, J, van Lonkhuijzen, L, Amsterdam Reproduction & Development (AR&D), CCA - Cancer Treatment and quality of life, and Obstetrics and gynaecology
- Subjects
Cancer Research ,medicine.medical_specialty ,Article ,Recurrence risk ,03 medical and health sciences ,0302 clinical medicine ,Risk groups ,Internal medicine ,Medicine ,In patient ,Cervical cancer ,030219 obstetrics & reproductive medicine ,Framingham Risk Score ,Surveillance ,business.industry ,Proportional hazards model ,medicine.disease ,3. Good health ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,Oncology ,030220 oncology & carcinogenesis ,Annual recurrence risk ,Cohort ,Prognostic model ,business - Abstract
Purpose Current guidelines for surveillance strategy in cervical cancer are rigid, recommending the same strategy for all survivors. The aim of this study was to develop a robust model allowing for individualised surveillance based on a patient's risk profile. Methods Data of 4343 early-stage patients with cervical cancer treated between 2007 and 2016 were obtained from the international SCCAN (Surveillance in Cervical Cancer) consortium. The Cox proportional hazards model predicting disease-free survival (DFS) was developed and internally validated. The risk score, derived from regression coefficients of the model, stratified the cohort into significantly distinctive risk groups. On its basis, the annual recurrence risk model (ARRM) was calculated. Results Five variables were included in the prognostic model: maximal pathologic tumour diameter; tumour histotype; grade; number of positive pelvic lymph nodes; and lymphovascular space invasion. Five risk groups significantly differing in prognosis were identified with a five-year DFS of 97.5%, 94.7%, 85.2% and 63.3% in increasing risk groups, whereas a two-year DFS in the highest risk group equalled 15.4%. Based on the ARRM, the annual recurrence risk in the lowest risk group was below 1% since the beginning of follow-up and declined below 1% at years three, four and >5 in the medium-risk groups. In the whole cohort, 26% of recurrences appeared at the first year of the follow-up, 48% by year two and 78% by year five. Conclusion The ARRM represents a potent tool for tailoring the surveillance strategy in early-stage patients with cervical cancer based on the patient's risk status and respective annual recurrence risk. It can easily be used in routine clinical settings internationally.
- Published
- 2021
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