Clinicopathologic characteristics and survival analysis in stage IVB cervical cancer with hematogenous metastasis

Background: The purpose of this study was to analyze the clinical characteristics, treatment modalities and prognosis of stage IVB cervical cancer patients with hematogenous metastasis. Methods: Between March 2005 and December 2017, a total of 160 patients FIGO (International Federation of Gynecology and Obstetrics, version 2018) stage IVB cervical cancer patients with hematogenous metastasis were included in this retrospective study. Patients were excluded from this analysis if they had lymphatic metastasis alone. Survival analyses included the Kaplan-Meier method, log-rank test, and Cox proportional hazards model. Results: Among 160 patients with hematogenous metastasis, 78 patients (48.8%, 78/160) exhibited only hematogenous metastases, while 82 (51.3%, 82/160) exhibited distant organ and lymph node (LN) metastases. Bone (37.5%, 60/160) was the most frequent metastatic site compared to lung (23.1%, 37/160) and liver (12.5%, 20/160). The median duration overall survival (OS) was 26 months and the 3-year OS rate was 35.3%. In univariate analysis, a significant difference was found in prognostic factors related to OS including tumor size (P=0.030), histology (P=0.006), white blood cell (WBC) count (P<0.001), squamous cell carcinoma antigen (SCCA) level (P=0.026), numbers of distant metastasis (P=0.017) and primary treatment (P=0.015). In multivariate analysis, the WBC was reported as an independent risk factor of progression free survival (PFS) (P=0.012, HR =3.25, 95% CI, 1.30-8.14) and OS (P=0.000, HR = 6.18, 95% CI, 2.39-15.95). In addition, chemoradiotherapy was found to prolong the OS of stage IVB cervical cancer patients with hematogenous metastasis (32 vs. 24 months, P=0.049, HR = 0.46, 95% CI, 0.21-0.99) compared with chemotherapy alone. Conclusions: For stage IVB cervical cancer with hematogenous metastasis, the WBC count was an independent recurrence and death risk factor. Also, stage IVB cervical cancer patients with hematogenous metastasis should not be treated with systemic chemotherapy alone, palliative radiotherapy should also be integrated into the treatment plan. However, future large scale prospective clinical trial was desperately in need.