J Cancer 2020; 11(6):1532-1541. doi:10.7150/jca.37390

Research Paper

Prognosis for different patterns of distant metastases in patients with uterine cervical cancer: a population-based analysis

Yiran Zhang1, Ying Guo2, Xinzi Zhou1, Xuena Wang1, Xiaofei Wang1✉

1. International Medical Center, Tianjin First Central Hospital, Tianjin, China.
2. Nursing department, Tianjin First Central Hospital, Tianjin, China.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Zhang Y, Guo Y, Zhou X, Wang X, Wang X. Prognosis for different patterns of distant metastases in patients with uterine cervical cancer: a population-based analysis. J Cancer 2020; 11(6):1532-1541. doi:10.7150/jca.37390. Available from https://www.jcancer.org/v11p1532.htm

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Background: Uterine cervical cancer (UCC) is a common malignant tumor in women. We conducted this work to provide a though description on the patterns of distant metastases and to investigate the relevant factors for prognosis of UCC patients based on a large population.

Patients and methods: UCC patients with FIGO stage IVB, being the study group, were identified from the Surveillance, Epidemiology, and End Result (SEER) database from 2010 to 2016. UCC patients with same inclusion criteria, being validation group, were identified from Tianjin First Central Hospital from 2004 to 2017. Patterns of distant metastases were described according to the number of metastatic sites. Survival of different patterns were calculated and prognostic factors were investigated by Cox hazard regression analysis.

Results: Distant metastases were recorded in 1448 UCC patients among whom 295 patients (30.8%) developed metastases in two or more organs. Compared with the median OS of 8 (95%CI, 7.07-8.93) months in the patients with the single site, worse survival of 5 (95%CI, 4.29-5.71) months was noticed in the patients with multiple metastases. Age ≥ 65 years, black race, higher grade, higher T stage and more metastatic sites were proved to be the prognostic factors for all the patients in the advanced stage and the results were partly validated in the validation cohort. Moreover, black race and higher T-stage for the patients with the single metastatic sites and age ≥ 65, uninsured status, surgical treatment and metastatic pattern for the patients with two metastatic sites were prognostic factors. No independent factor was found in patients with three or more metastases.

Conclusion: Around 70% of the patients suffered one site distant metastasis in UCC patients with IVB stage while 30% with multiple metastases and a significantly reduced survival. Different survivals and prognostic factors were noticed for different patterns of distant metastases.

Keywords: Uterine cervical cancer, SEER, distant metastases, prognostic factor