- Email: [email protected]
Oncologic outcomes of adjuvant chemotherapy in patients with risk factors after radical surgery in FIGO stage IB–IIA cervical cancer
8
Abstracts / Gynecologic Oncology 145 (2017) 2–220
with ovarian clear cell carcinoma (CCC). To understand the immunological background of CCC and to explore potential biomarkers, neoantigen load and local immune profile were assessed by integrated molecular analysis of CCC. Methods: A total of 74 cases of CCC were analyzed in this study. Exome sequencing and expression array were performed for those tumors. Mutations, neoantigen load, antigen presentation machinery, and immune profile were investigated; the relationship between clinical outcomes was also analyzed. Results: Neither number of mutations nor neoantigens correlated with clinical outcomes in CCC. Gene expression levels of infiltrated immune cells did not correlate with outcomes as well. However, a high number of mutations in CCC as compared to high-grade serous carcinoma in The Cancer Genome Atlas cohort was observed. To determine whether the high mutation rate observed in CCC could result in immunoediting, the number of neoepitopes per mutation (neoantigen frequency) was further analyzed. A correlation between high neoantigen frequency with decreased progression-free survival (PFS) (P = 0.011) was found. A Cox multivariate regression analysis demonstrated that the high neoantigen frequency was an independent prognostic factor for PFS (P = 0.032). Immune-related genes were frequently highly expressed in tumors with low neoantigen frequency, suggesting evidence of immunoediting in the low-neoantigen-frequency group. In contrast, we observed decreased human leukocyte anigen class I expression (P = 0.036) as well as increased PD1/CD8 ratio (P = 0.017) in tumors with high neoantigen frequency. These results suggest that tumors with high neoantigen frequency in CCC might have received insufficient immunoediting due to an immunosuppressive tumor microenvironment. Conclusions: Neoantigen frequency in CCC is an independent prognostic factor for clinical outcome and a potential candidate biomarker for an immune checkpoint inhibitor-based treatment. doi:10.1016/j.ygyno.2017.03.039
Sunrise Seminar I: Narcotics and Limitation Monday, March 13, 2017 Moderator: Carolyn Lefkowits, MD, University of Denver, Denver, CO, USA
Results: Our cohort of 102 women had a median age of 49 years. Rates of persistent opioid use at 3 and 6 months after treatment were 32% and 28%, respectively. Table 1 summarizes patient characteristics and differences between patients using and not using opioids at 6 months. Patients with persistent opioid use were more likely to be b40 years old, have disease outside the pelvis, and have a history of substance abuse or depression and/or anxiety (all P b 0.05). There was a significant association between opioid use at 6 months and subsequent recurrence or death during the study period. In multivariable logistic regression, disease outside the pelvis (aOR = 15.06, CI 1.01–223.73), history of substance abuse (aOR = 6.21, CI 1.08–35.67), and history of depression and/or anxiety (aOR = 6.28, CI 1.70–23.30) remained statistically significant independent predictors of opioid use at 6 months. Conclusion: In our cohort of cervical cancer survivors, 28% were still using opioids at 6 months after completion of radiation. Risk factors for persistent use at 6 months overlap with known risk factors for opioid misuse. As we strive to balance opioid safety and efficacy, cervical cancer survivors with history of radiation, particularly those who are young or have history of depression, anxiety, or substance abuse, may benefit from incorporating nonopioid methods of pain control and additional support.
Table 1
Age b 40 White Race Married Employed Squamous histology Disease outside the pelvis Radiation adjuvant (vs definitive) Tobacco use (ever) Substance abuse history History of depression and/or anxiety Developed recurrence Died
Total Not Using (n = 102) Opioids at 6 Months (n = 77)
Persistent p-value Opioid Use at 6 Months (n = 29)
25% 65% 42% 67% 75% 8% 36% 49% 9% 48%
18% 65% 46% 63% 74% 3% 40% 47% 4% 36%
41% 66% 31% 67% 76% 22% 28% 55% 21% 79%
0.01 0.91 0.15 0.72 0.76 0.01 0.25 0.36 0.02 b0.001
22% 8%
15% 4%
38% 17%
0.01 0.04
13 - Sunrise Seminar doi:10.1016/j.ygyno.2017.03.040 Cervical cancer survivors have high rates of persistent opioid use at 6 months after radiation K. Warda, A.A. Ramzanb, J. Sheederb, S. Fischerb, C. Lefkowitsb. a University of Colorado Hospital, Aurora, CO, USA, bUniversity of Colorado Denver, Denver, CO, USA Objective: Opioid misuse has been characterized as a public health crisis. Recent American Society of Clinical Oncology guidelines for pain in cancer survivors recommend considering opioid use only in patients who have not responded to conservative management and have persistent distress or functional impairment. Patients with active cervical cancer have been shown to have high rates of opioid use. Patterns of opioid use in cervical cancer survivors have not been previously described. Method: Women with cervical cancer treated with radiation between 2011 and 2015 at a single institution were identified. Charts were reviewed for demographics, disease, and treatment characteristics and opioid prescription history. Primary outcome was opioid use at 6 months after completion of radiation. Women whose disease recurred in less than 6 months were excluded. Data were analyzed using χ2 test, Fisher exact test, and multivariable logistic regression.
Scientific Plenary III: Contemporary Clinical Controversies Monday, March 13, 2017 Moderators: J. Spencer Thompson, MD, Oklahoma Stephenson Cancer Center, Oklahoma City, OK, USA Madeleine Courtney-Brooks, MD, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA 14 - Scientific Plenary Oncologic outcomes of adjuvant chemotherapy in patients with risk factors after radical surgery in FIGO stage IB–IIA cervical cancer K.B. Leea, J.M. Leeb, Y.S. Kima. aGachon University Gil Medical Center, Incheon, South Korea, bKyung Hee University East-West Neo Medical Center, Seoul, South Korea Objective: To determine oncologic outcomes of chemotherapy alone without radiation as adjuvant therapy for patients with FIGO stage IB–IIA cervical cancer who were treated initially by radical surgery and had risk factors.
Abstracts / Gynecologic Oncology 145 (2017) 2–220
Method: Between March 1996 and December 2014, 101 consecutive patients with clinical stage IB-IIA cervical cancer underwent type C2 radical hysterectomy and pelvic lymph node (PLN) dissection with or without paraaortic lymph node (PALN) dissection at the Gachon University Gil Medical Center (Incheon, Korea) and Kyung Hee University Hospital at Gangdong (Seoul, Korea). None of the patients had received any treatment prior to surgery. All patient data used in this study were collected retrospectively, and the data were analyzed after approval by the institutional review boards of the participating institutes. After pathologic assessment, adjuvant chemotherapy was given to patients who had a combination of 3 risk factors, which is similar to the criteria of GOG protocol 92 (Sedlis A et al., Gynecol Oncol. 1999:177-83), or with ≥ 1 lymph node metastasis. Chemotherapeutic regimens consisted of either platinum alone or platinum-based combination. All endpoints were last updated in July 2016. Results: The patients' characteristics are shown in Table 1. There were 76 patients with a combination of the 3 risk factors without lymph node metastasis (Table 2). Twenty-five patients had ≥ 1 lymph node metastasis regardless of the 3 risk factors: 21 with only PLN metastasis and 4 with PLN and PALN metastasis. Fourteen of the 101 patients suffered from recurrence (Table 3). Median follow-up time for the patients was 65 months (range 19 to ~ 108). In all the patients, the estimated 3-year disease-free survival (DFS) rate was 90.7%; the estimated 5-year overall survival (OS) was 90.6%; and the 5-year cervical cancer-specific OS rate was 94.7% (Fig. 1). In the patients with a combination of 3 risk factors, the 3-year DFS rate was 94.6%; the 5-year OS rate was 90.6%; and the disease-specific 5-year survival rate was 96.2% (Fig. 2). In the patients with lymph node metastasis, the 3-year DFS rate was 79.4%; the 5-year OS rate was 90.6%; and the disease-specific 5-year survival rate was 90.6% (Fig. 3). The causes of death unrelated to cervical cancer were car accident, tongue cancer, myocardial infarction, and brain stroke. Conclusion: Adjuvant chemotherapy alone might be effective in patients with FIGO stage IB–IIA cervical cancer with surgically confirmed risk factors.
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Table 2 Combination of the three risk factors without positive lymph node (n = 76). LVSI
DOI
Tumor size
No. (%)
Positive Positive Negative Positive
Deep 1/3 Middle 1/3 Deep or Middle 1/3 Superficial 1/3
Any ≥ 2cm ≥ 4cm ≥/3rfi
29 (38.2) 27 (35.6) 18 (23.7) 2 (1.5)
*LVSI; lymphovascular space invasion, DOI; depth of stroma invasion.
Table 3 Disease relapse pattern and salvage treatment. Age
Stage
TS (cm)
DOI
LVSI
LNM
RS
ST
PS
Patients with combination of the three risk factor without lymph node metastasis Case 1 52 IB1 1.5 Deep Yes No Vulva CCRT NED Case 2 40 IB1 4.9 Middle Yes No Pelvis Surgery NED Case 3 42 IB2 4.5 Middle Yes No Pelvis CCRT NED Case 4 65 IB1 2.9 Deep Yes No Vagina RT AWD Case 5 44 IB2 4.5 Deep Yes No Brain RT AWD Case 6 52 IB1 2.0 Middle Yes No Lung CTX AWD Case 7 40 IB1 3.2 Middle Yes No Vagina RT AWD Case 8 49 IB1 5.5 Deep Yes No Lung CTX Dead Case 9 72 IB2 3.7 Deep No No Lung CTX Dead Patients with lymph node metastasis irrespective the three Case 10 37 IB1 2.9 Deep Yes Yes Case 11 40 IB1 2.0 Deep Yes Yes Case 12 66 IB1 4.0 Deep Yes Yes Case 13 49 IB2 4.5 Deep Yes Yes Case 14 50 IB2 3.0 Deep Yes Yes
risk factors Vagina RT Vagina CCRT Lung RT Lung CTX PALN CTX
NED AWD Dead Dead Dead
*TS; pathologic large tumor size, DOI; depth of stromal invasion, LVSI; lymphovascular space invasion, LNM; lymph node metastasis, RS; recur site, PALN; paraaortic lymph node, ST; salvage treatment, CCRT; concurrent chemoradiotherapy, RT; radiotherapy, CTX; chemotherapy, PS; present status, NED; no evidence of disease, AWD; alive with disease.
Table 1 Patient’s characteristics (n = 101). Age, mean (range), y Body mass index (range) Parity (range) Menopause Yes No Clinical stage (%) IB1 IB2 IIA Histology (%) Squamous Adenocarcinoma Adenosquamous Others Pathologic large tumor diameter, mean (range), cm No. of retrieved pelvic lymph node, mean (range) No. of pelvic lymph node metastasis, mean (range) No. of patients undergoing pelvic and paraaortic lymph dissection No. of retrieved paraaortic lymph node, mean (range) No. of paraaortic lymph node metastasis, mean (range) Safety margin of vagina, mean (range), cm Chemotherapy regimen (%) Single Platinum Paclitaxel and platinum Cycles of Chemotherapy (%) 3 cycles 6 cycles
47.1 (23 ~ 73) 23.7 (17.5 ~ 31.6) 2.0 (0 ~ 5) 34 (33.7) 67 (66.3) 74 (73.3) 23 (22.8) 4 (3.9) 75 (74.3) 15 (14.9) 6 (5.9) 5 (4.9) 3.89 (1 ~ 8) 54.5 (16 ~ 101) 4.58 (1 ~ 33) 50 11.2 (2 ~ 30) 5.5 (1 ~ 17) 1.75 (0.4 ~ 4.5) 47 (47) 54 (53) 31 (31) 70 (69)
Fig. 1. In all the patients, the 3-year disease survival rates were 90.7%, the 5-year overall survival rates were 90.6%, and the disease specific 5-year survival rates were 94.7%.
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Abstracts / Gynecologic Oncology 145 (2017) 2–220
15 - Scientific Plenary Stage IA-IIA cervical cancer: Disparities in adherence to treatment guidelines and survival in California K.S. Pfaendlera, J. Changb, A. Ziogasb, R.E. Bristowa, K.R. Pennerc. a University of California, Irvine Medical Center, Orange, CA, USA, b University of California, Irvine, Irvine, CA, USA, cUniversity of California Irvine Medical Center, Orange, CA, USA
Fig. 2. In the patients with combination of three risk factors, the 3-year disease free survival rates were 94.6%, the 5-year overall survival rates were 90.6%, and the disease specific 5-year survival rates were 96.2%.
Objective: (1) To evaluate the impact of sociodemographic and hospital characteristics on adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines for stage IA-IIA cervical cancer. (2) To analyze the relationship between adherence to NCCN guidelines and survival for early-stage cervical cancer patients. Method: This is a retrospective population-based cohort study of stage IA-IIA invasive cervical cancer cases reported to the California Cancer Registry January 1, 1995, to December 31, 2010. Adherence to NCCN guideline care was defined by stage-appropriate surgical procedures, radiation, and chemotherapy according to the year of diagnosis. Multivariate logistic regression and Cox proportional hazards models were used to examine the relationships of patient, tumor, and treatment characteristics with NCCN guideline adherence and cervical cancer-specific survival. Results: A total of 10,127 patients were identified, of whom 62.9% received NCCN guideline-adherent care and 17.7% were treated in high-volume centers (≥20 cases/year). On multivariate analysis, lowest and low-middle SES (OR = 0.75 and OR = 0.80, respectively), older age (OR = 0.99), Charlson comorbidity score N0 (OR = 0.76), tumor size ≥2 cm (OR = 0.48), and stage II disease (OR = 0.49) were all associated with nonguideline-adherent-care (all P b 0.01). Treatment at a low-volume center (b20 cases/year) was an independent risk factor for nonguideline-adherent care (OR = 0.88, 95% CI 0.79– 0.99, P = 0.04). Nonguideline-adherent care was an independent predictor of inferior cervical cancer-specific survival (HR = 2.03, 95% CI 1.70–2.42, P b 0.0001), as was treatment in a low-volume center (HR = 1.28, 95% CI 1.05–1.63, P = 0.04). Patient characteristics associated with decreased cervical cancer-specific survival included black race (HR = 1.60), Medicaid payer status (HR = 1.57), and Charlson comorbidity score N0 (HR = 1.91) (all P b 0.01). (See Fig. 1.) Conclusion: For patients with early-stage cervical cancer in California, the majority of patients were treated at a low-volume center, which was an independent risk factor for deviation from NCCN treatment guidelines. Both treatment in a high-volume center and
Fig. 3. In the patients with lymph node metastasis, the 3-year disease free survival rates were 79.4%, the 5-year overall survival rates were 90.6%, and the disease specific 5-year survival rates were 90.6%.
doi:10.1016/j.ygyno.2017.03.041 Fig. 1.
Abstracts / Gynecologic Oncology 145 (2017) 2–220
with ovarian clear cell carcinoma (CCC). To understand the immunological background of CCC and to explore potential biomarkers, neoantigen load and local immune profile were assessed by integrated molecular analysis of CCC. Methods: A total of 74 cases of CCC were analyzed in this study. Exome sequencing and expression array were performed for those tumors. Mutations, neoantigen load, antigen presentation machinery, and immune profile were investigated; the relationship between clinical outcomes was also analyzed. Results: Neither number of mutations nor neoantigens correlated with clinical outcomes in CCC. Gene expression levels of infiltrated immune cells did not correlate with outcomes as well. However, a high number of mutations in CCC as compared to high-grade serous carcinoma in The Cancer Genome Atlas cohort was observed. To determine whether the high mutation rate observed in CCC could result in immunoediting, the number of neoepitopes per mutation (neoantigen frequency) was further analyzed. A correlation between high neoantigen frequency with decreased progression-free survival (PFS) (P = 0.011) was found. A Cox multivariate regression analysis demonstrated that the high neoantigen frequency was an independent prognostic factor for PFS (P = 0.032). Immune-related genes were frequently highly expressed in tumors with low neoantigen frequency, suggesting evidence of immunoediting in the low-neoantigen-frequency group. In contrast, we observed decreased human leukocyte anigen class I expression (P = 0.036) as well as increased PD1/CD8 ratio (P = 0.017) in tumors with high neoantigen frequency. These results suggest that tumors with high neoantigen frequency in CCC might have received insufficient immunoediting due to an immunosuppressive tumor microenvironment. Conclusions: Neoantigen frequency in CCC is an independent prognostic factor for clinical outcome and a potential candidate biomarker for an immune checkpoint inhibitor-based treatment. doi:10.1016/j.ygyno.2017.03.039
Sunrise Seminar I: Narcotics and Limitation Monday, March 13, 2017 Moderator: Carolyn Lefkowits, MD, University of Denver, Denver, CO, USA
Results: Our cohort of 102 women had a median age of 49 years. Rates of persistent opioid use at 3 and 6 months after treatment were 32% and 28%, respectively. Table 1 summarizes patient characteristics and differences between patients using and not using opioids at 6 months. Patients with persistent opioid use were more likely to be b40 years old, have disease outside the pelvis, and have a history of substance abuse or depression and/or anxiety (all P b 0.05). There was a significant association between opioid use at 6 months and subsequent recurrence or death during the study period. In multivariable logistic regression, disease outside the pelvis (aOR = 15.06, CI 1.01–223.73), history of substance abuse (aOR = 6.21, CI 1.08–35.67), and history of depression and/or anxiety (aOR = 6.28, CI 1.70–23.30) remained statistically significant independent predictors of opioid use at 6 months. Conclusion: In our cohort of cervical cancer survivors, 28% were still using opioids at 6 months after completion of radiation. Risk factors for persistent use at 6 months overlap with known risk factors for opioid misuse. As we strive to balance opioid safety and efficacy, cervical cancer survivors with history of radiation, particularly those who are young or have history of depression, anxiety, or substance abuse, may benefit from incorporating nonopioid methods of pain control and additional support.
Table 1
Age b 40 White Race Married Employed Squamous histology Disease outside the pelvis Radiation adjuvant (vs definitive) Tobacco use (ever) Substance abuse history History of depression and/or anxiety Developed recurrence Died
Total Not Using (n = 102) Opioids at 6 Months (n = 77)
Persistent p-value Opioid Use at 6 Months (n = 29)
25% 65% 42% 67% 75% 8% 36% 49% 9% 48%
18% 65% 46% 63% 74% 3% 40% 47% 4% 36%
41% 66% 31% 67% 76% 22% 28% 55% 21% 79%
0.01 0.91 0.15 0.72 0.76 0.01 0.25 0.36 0.02 b0.001
22% 8%
15% 4%
38% 17%
0.01 0.04
13 - Sunrise Seminar doi:10.1016/j.ygyno.2017.03.040 Cervical cancer survivors have high rates of persistent opioid use at 6 months after radiation K. Warda, A.A. Ramzanb, J. Sheederb, S. Fischerb, C. Lefkowitsb. a University of Colorado Hospital, Aurora, CO, USA, bUniversity of Colorado Denver, Denver, CO, USA Objective: Opioid misuse has been characterized as a public health crisis. Recent American Society of Clinical Oncology guidelines for pain in cancer survivors recommend considering opioid use only in patients who have not responded to conservative management and have persistent distress or functional impairment. Patients with active cervical cancer have been shown to have high rates of opioid use. Patterns of opioid use in cervical cancer survivors have not been previously described. Method: Women with cervical cancer treated with radiation between 2011 and 2015 at a single institution were identified. Charts were reviewed for demographics, disease, and treatment characteristics and opioid prescription history. Primary outcome was opioid use at 6 months after completion of radiation. Women whose disease recurred in less than 6 months were excluded. Data were analyzed using χ2 test, Fisher exact test, and multivariable logistic regression.
Scientific Plenary III: Contemporary Clinical Controversies Monday, March 13, 2017 Moderators: J. Spencer Thompson, MD, Oklahoma Stephenson Cancer Center, Oklahoma City, OK, USA Madeleine Courtney-Brooks, MD, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA 14 - Scientific Plenary Oncologic outcomes of adjuvant chemotherapy in patients with risk factors after radical surgery in FIGO stage IB–IIA cervical cancer K.B. Leea, J.M. Leeb, Y.S. Kima. aGachon University Gil Medical Center, Incheon, South Korea, bKyung Hee University East-West Neo Medical Center, Seoul, South Korea Objective: To determine oncologic outcomes of chemotherapy alone without radiation as adjuvant therapy for patients with FIGO stage IB–IIA cervical cancer who were treated initially by radical surgery and had risk factors.
Abstracts / Gynecologic Oncology 145 (2017) 2–220
Method: Between March 1996 and December 2014, 101 consecutive patients with clinical stage IB-IIA cervical cancer underwent type C2 radical hysterectomy and pelvic lymph node (PLN) dissection with or without paraaortic lymph node (PALN) dissection at the Gachon University Gil Medical Center (Incheon, Korea) and Kyung Hee University Hospital at Gangdong (Seoul, Korea). None of the patients had received any treatment prior to surgery. All patient data used in this study were collected retrospectively, and the data were analyzed after approval by the institutional review boards of the participating institutes. After pathologic assessment, adjuvant chemotherapy was given to patients who had a combination of 3 risk factors, which is similar to the criteria of GOG protocol 92 (Sedlis A et al., Gynecol Oncol. 1999:177-83), or with ≥ 1 lymph node metastasis. Chemotherapeutic regimens consisted of either platinum alone or platinum-based combination. All endpoints were last updated in July 2016. Results: The patients' characteristics are shown in Table 1. There were 76 patients with a combination of the 3 risk factors without lymph node metastasis (Table 2). Twenty-five patients had ≥ 1 lymph node metastasis regardless of the 3 risk factors: 21 with only PLN metastasis and 4 with PLN and PALN metastasis. Fourteen of the 101 patients suffered from recurrence (Table 3). Median follow-up time for the patients was 65 months (range 19 to ~ 108). In all the patients, the estimated 3-year disease-free survival (DFS) rate was 90.7%; the estimated 5-year overall survival (OS) was 90.6%; and the 5-year cervical cancer-specific OS rate was 94.7% (Fig. 1). In the patients with a combination of 3 risk factors, the 3-year DFS rate was 94.6%; the 5-year OS rate was 90.6%; and the disease-specific 5-year survival rate was 96.2% (Fig. 2). In the patients with lymph node metastasis, the 3-year DFS rate was 79.4%; the 5-year OS rate was 90.6%; and the disease-specific 5-year survival rate was 90.6% (Fig. 3). The causes of death unrelated to cervical cancer were car accident, tongue cancer, myocardial infarction, and brain stroke. Conclusion: Adjuvant chemotherapy alone might be effective in patients with FIGO stage IB–IIA cervical cancer with surgically confirmed risk factors.
9
Table 2 Combination of the three risk factors without positive lymph node (n = 76). LVSI
DOI
Tumor size
No. (%)
Positive Positive Negative Positive
Deep 1/3 Middle 1/3 Deep or Middle 1/3 Superficial 1/3
Any ≥ 2cm ≥ 4cm ≥/3rfi
29 (38.2) 27 (35.6) 18 (23.7) 2 (1.5)
*LVSI; lymphovascular space invasion, DOI; depth of stroma invasion.
Table 3 Disease relapse pattern and salvage treatment. Age
Stage
TS (cm)
DOI
LVSI
LNM
RS
ST
PS
Patients with combination of the three risk factor without lymph node metastasis Case 1 52 IB1 1.5 Deep Yes No Vulva CCRT NED Case 2 40 IB1 4.9 Middle Yes No Pelvis Surgery NED Case 3 42 IB2 4.5 Middle Yes No Pelvis CCRT NED Case 4 65 IB1 2.9 Deep Yes No Vagina RT AWD Case 5 44 IB2 4.5 Deep Yes No Brain RT AWD Case 6 52 IB1 2.0 Middle Yes No Lung CTX AWD Case 7 40 IB1 3.2 Middle Yes No Vagina RT AWD Case 8 49 IB1 5.5 Deep Yes No Lung CTX Dead Case 9 72 IB2 3.7 Deep No No Lung CTX Dead Patients with lymph node metastasis irrespective the three Case 10 37 IB1 2.9 Deep Yes Yes Case 11 40 IB1 2.0 Deep Yes Yes Case 12 66 IB1 4.0 Deep Yes Yes Case 13 49 IB2 4.5 Deep Yes Yes Case 14 50 IB2 3.0 Deep Yes Yes
risk factors Vagina RT Vagina CCRT Lung RT Lung CTX PALN CTX
NED AWD Dead Dead Dead
*TS; pathologic large tumor size, DOI; depth of stromal invasion, LVSI; lymphovascular space invasion, LNM; lymph node metastasis, RS; recur site, PALN; paraaortic lymph node, ST; salvage treatment, CCRT; concurrent chemoradiotherapy, RT; radiotherapy, CTX; chemotherapy, PS; present status, NED; no evidence of disease, AWD; alive with disease.
Table 1 Patient’s characteristics (n = 101). Age, mean (range), y Body mass index (range) Parity (range) Menopause Yes No Clinical stage (%) IB1 IB2 IIA Histology (%) Squamous Adenocarcinoma Adenosquamous Others Pathologic large tumor diameter, mean (range), cm No. of retrieved pelvic lymph node, mean (range) No. of pelvic lymph node metastasis, mean (range) No. of patients undergoing pelvic and paraaortic lymph dissection No. of retrieved paraaortic lymph node, mean (range) No. of paraaortic lymph node metastasis, mean (range) Safety margin of vagina, mean (range), cm Chemotherapy regimen (%) Single Platinum Paclitaxel and platinum Cycles of Chemotherapy (%) 3 cycles 6 cycles
47.1 (23 ~ 73) 23.7 (17.5 ~ 31.6) 2.0 (0 ~ 5) 34 (33.7) 67 (66.3) 74 (73.3) 23 (22.8) 4 (3.9) 75 (74.3) 15 (14.9) 6 (5.9) 5 (4.9) 3.89 (1 ~ 8) 54.5 (16 ~ 101) 4.58 (1 ~ 33) 50 11.2 (2 ~ 30) 5.5 (1 ~ 17) 1.75 (0.4 ~ 4.5) 47 (47) 54 (53) 31 (31) 70 (69)
Fig. 1. In all the patients, the 3-year disease survival rates were 90.7%, the 5-year overall survival rates were 90.6%, and the disease specific 5-year survival rates were 94.7%.
10
Abstracts / Gynecologic Oncology 145 (2017) 2–220
15 - Scientific Plenary Stage IA-IIA cervical cancer: Disparities in adherence to treatment guidelines and survival in California K.S. Pfaendlera, J. Changb, A. Ziogasb, R.E. Bristowa, K.R. Pennerc. a University of California, Irvine Medical Center, Orange, CA, USA, b University of California, Irvine, Irvine, CA, USA, cUniversity of California Irvine Medical Center, Orange, CA, USA
Fig. 2. In the patients with combination of three risk factors, the 3-year disease free survival rates were 94.6%, the 5-year overall survival rates were 90.6%, and the disease specific 5-year survival rates were 96.2%.
Objective: (1) To evaluate the impact of sociodemographic and hospital characteristics on adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines for stage IA-IIA cervical cancer. (2) To analyze the relationship between adherence to NCCN guidelines and survival for early-stage cervical cancer patients. Method: This is a retrospective population-based cohort study of stage IA-IIA invasive cervical cancer cases reported to the California Cancer Registry January 1, 1995, to December 31, 2010. Adherence to NCCN guideline care was defined by stage-appropriate surgical procedures, radiation, and chemotherapy according to the year of diagnosis. Multivariate logistic regression and Cox proportional hazards models were used to examine the relationships of patient, tumor, and treatment characteristics with NCCN guideline adherence and cervical cancer-specific survival. Results: A total of 10,127 patients were identified, of whom 62.9% received NCCN guideline-adherent care and 17.7% were treated in high-volume centers (≥20 cases/year). On multivariate analysis, lowest and low-middle SES (OR = 0.75 and OR = 0.80, respectively), older age (OR = 0.99), Charlson comorbidity score N0 (OR = 0.76), tumor size ≥2 cm (OR = 0.48), and stage II disease (OR = 0.49) were all associated with nonguideline-adherent-care (all P b 0.01). Treatment at a low-volume center (b20 cases/year) was an independent risk factor for nonguideline-adherent care (OR = 0.88, 95% CI 0.79– 0.99, P = 0.04). Nonguideline-adherent care was an independent predictor of inferior cervical cancer-specific survival (HR = 2.03, 95% CI 1.70–2.42, P b 0.0001), as was treatment in a low-volume center (HR = 1.28, 95% CI 1.05–1.63, P = 0.04). Patient characteristics associated with decreased cervical cancer-specific survival included black race (HR = 1.60), Medicaid payer status (HR = 1.57), and Charlson comorbidity score N0 (HR = 1.91) (all P b 0.01). (See Fig. 1.) Conclusion: For patients with early-stage cervical cancer in California, the majority of patients were treated at a low-volume center, which was an independent risk factor for deviation from NCCN treatment guidelines. Both treatment in a high-volume center and
Fig. 3. In the patients with lymph node metastasis, the 3-year disease free survival rates were 79.4%, the 5-year overall survival rates were 90.6%, and the disease specific 5-year survival rates were 90.6%.
doi:10.1016/j.ygyno.2017.03.041 Fig. 1.