Posttherapy surveillance of women with cervical cancer: An outcomes analysis

Objective. The aim of this study was to develop a surveillance program that optimizes clinical outcome following primary treatment of women with cervical cancer. Methods. The records of 1096 patients with FIGO stage IB cervical cancer treated from 1983 to 1993 were retrospectively reviewed. Recurrence was analyzed by site, presence or absence of symptoms, method of detection, and survival, Univariate and multivariate analyses using a Cox proportional hazards model were performed. Results. One hundred thirty-three patients (13%) developed recurrent disease, Of these, 114 were symptomatic and 19 were asymptomatic at the time of recurrence. Thirty-seven patients recurred in the central pelvis, 21 each in the lung or pelvic wall, 22 in nodes, and 35 in other sites. The median disease-free interval was 17 months for symptomatic patients and 16 months for asymptomatic patients. The median survival from initial diagnosis was 31 months for symptomatic and 83 months for asymptomatic patients (P = 0.001), The median survival from recurrence was 11 months for symptomatic and 42 months for asymptomatic patients (P < 0.001), Multivariate analysis revealed that symptom status at time of recurrence was a significant predictor of survival, even when known prognostic factors were considered (P < 0.001). All asymptomatic pelvic recurrences were diagnosed by pelvic exam; all asymptomatic pulmonary recurrences were detected by chest radiographs. Pap smears did not detect a single asymptomatic recurrence. Conclusions. Posttherapy surveillance programs are directed toward asymptomatic patients in whom early detection of recurrence may impact survival. These data indicate that a subset of women may benefit from surveillance. A model for surveillance is proposed. (C) 2000 Academic Press.