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Vaginal cuff length during radical hysterectomy is a prognostic factor for stage IB-IIA cervical cancer: a retrospective study

Authors Zuo N, Hu H, Thapa N, Li Z, Jiang D, Meng X, Yang J, Chen X, Cai H

Received 1 June 2018

Accepted for publication 30 August 2018

Published 19 November 2018 Volume 2018:10 Pages 5927—5935

DOI https://doi.org/10.2147/CMAR.S175726

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 3

Editor who approved publication: Professor Nakshatri


Na Zuo,1,* Hongzhen Hu,1,2,* Niresh Thapa,1,3 Zhen Li,1 Daqiong Jiang,1 Xiangyu Meng,4 Jing Yang,1 Xiaoxing Chen,5 Hongbing Cai1

1Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan 430071, Hubei, People’s Republic of China; 2Department of Obstetrics and Gynecology, Shenzhen Futian Maternity and Child Care Hospital, Shenzhen 518030, Guangdong, People’s Republic of China; 3Karnali Academy of Health Sciences, Jumla, Nepal; 4Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College of Wuhan University, Wuhan 430071, Hubei, People’s Republic of China; 5Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Intestinal and Colorectal Diseases, Wuhan 430071, Hubei, People’s Republic of China

*These authors contributed equally to this work

Purpose: The aim of this study was to investigate the impact of vaginal cuff length (VCL) resected during radical hysterectomy (RH) on the long-term survival outcomes of patients with cervical cancer (International Federation of Gynecology and Obstetrics [FIGO] stage IB–IIA) and to explore whether VCL is a prognostic factor for cervical cancer.
Methods: A total of 435 eligible patients with stage IB and IIA cervical cancer who underwent RH in Zhongnan Hospital of Wuhan University (Wuhan, People’s Republic of China) from January 2007 to February 2017 were retrospectively analyzed. These patients were divided into two groups (VCL ≤2.0 cm and >2.0 cm) for further analysis according to the VCL during RH. The Kaplan–Meier method was adopted to calculate the survival rates. Univariate and multivariate Cox regression models were used to analyze independent prognosis factors for survival.
Results: Of the 435 identified patients, 196 had VCL ≤2.0 cm and 239 had VCL >2.0 cm after RH. The 5-year disease-free survival (DFS) for the group who had VCL ≤2.0 cm vs the group who had VCL >2.0 cm was 68.1% vs 87.5% (P<0.001). Correspondingly, the overall survival (OS) for the two groups was 71.4% vs 89.2% (P<0.001). More interestingly, the VCL was significantly associated with the 5-year local recurrence rate, but not associated with the distant metastasis rate. In addition to the VCL, FIGO stage and lymph node involvement were also identified as significant prognostic factors for cervical cancer.
Conclusion: Resection of VCL >2.0 cm in RH has a more favorable long-term outcome than VCL ≤2.0 cm among patients with cervical cancer (FIGO stage IB–IIA); shorter VCL resection was significantly associated with local recurrence, DFS, and OS; thus, it can be considered as a prognostic factor for cervical cancer.

Keywords: cervical cancer, vaginal cuff length, lymph node involvement, prognosis, local recurrence, distant metastasis

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