SUCCOR Risk: Design and Validation of a Recurrence Prediction Index for Early-Stage Cervical Cancer
Nabil Manzour, Luis Chiva, Enrique Chacón, Nerea Martín‐Calvo, Félix Boria, José Ángel Mínguez, Juan Luis Alcázar, On behalf of the SUCCOR Study Group, Vanna Zanagnolo, Denis Querleu, Mihai Emil Căpîlna, Anna Fagotti, Ali Kucukmetin, Constantijne H. Mom, G Chakalova, Shamistan Aliyev, Mario Malzoni, Fabrice Narducci, Octavio Arencibia, Francesci Raspagliesi, Tayfun Toptaş, David Cibula, Dilyara Kaidarova, Mehmet Mutlu Meydanlı, Mariana Vide Tavares, Dmytro Golub, Anna Myriam Perrone, Ròbert Póka, Dimitrios Tsolakidis, Goran Vujić, Marcin Jędryka, Petra L.M. Zusterzeel, Jogchum Beltman, Frédéric Goffin, Dimitros Haidopoulos, Herman Haller, Robert Jach, Iryna Yezhova, Igor Berlev, Margarida Bernardino, Rasiah Bharathan, Maximilian Lanner, Vladyslav Sukhin, Jean Guillaume Féron, Robert Fruscio, Kersti Kukk, Jordi Ponce, Nabil Abdalla, Özgür Akbayır, Sedat Akgöl, Elif Akşahin, Shamistan Aliyev, María Alonso-Espías, Игор Алулоски, Cláudia Regina Furquim de Andrade, Nikola Badzakov, Rosa Barrachina, Giorgio Bogani, Eduard-Aexandru Bonci, Hélène Bonsang‐Kitzis, Cosima Brucker, L. M. Cardenas, Andrea Casajuana, Pere Cavallé, Jorge Cea, Benito Chiofalo, Gloria Cordeiro, Pluvio Coronado, María Cuadra, Javier Dı́ez, Teresa Diniz da Costa, Santiago Domingo, Lukáš Dostálek, Fuat Demirkiran, Diego Erasun, Mathias K. Fehr, Sergi Fernández-González, Soledad Fidalgo, Gabriel Fiol, Khadra Galaal, José Alenza García, Gerhard Gebauer, Fabio Ghezzi, Juan Gilabert, Nana Gomes, Elisabete Gonçalves, Virginia González, Frédéric Grandjean, Miriam Guijarro, Frédéric Guyon, Jolien Haesen, Ginés Hernández-Cortes, Sofía Herrero, Imre Pete, Ioannis Kalogiannidis, Erbil Karaman, Andreas Kavallaris, Łukasz Klasa, Ioannis Kotsopoulos, S Kovachev
Abstract
OBJECTIVE: Based on the SUCCOR study database, our primary objective was to identify the independent clinical pathological variables associated with the risk of relapse in patients with stage IB1 cervical cancer who underwent a radical hysterectomy. Our secondary goal was to design and validate a risk predictive index (RPI) for classifying patients depending on the risk of recurrence. METHODS: Overall, 1116 women were included from January 2013 to December 2014. We randomly divided our sample into two cohorts: discovery and validation cohorts. The test group was used to identify the independent variables associated with relapse, and with these variables, we designed our RPI. The index was applied to calculate a relapse risk score for each participant in the validation group. RESULTS: A previous cone biopsy was the most significant independent variable that lowered the rate of relapse (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.17-0.60). Additionally, patients with a tumor diameter >2 cm on preoperative imaging assessment (OR 2.15, 95% CI 1.33-3.5) and operated by the minimally invasive approach (OR 1.61, 95% CI 1.00-2.57) were more likely to have a recurrence. Based on these findings, patients in the validation cohort were classified according to the RPI of low, medium, or high risk of relapse, with rates of 3.4%, 9.8%, and 21.3% observed in each group, respectively. With a median follow-up of 58 months, the 5-year disease-free survival rates were 97.2% for the low-risk group, 88.0% for the medium-risk group, and 80.5% for the high-risk group (p < 0.001). CONCLUSION: Previous conization to radical hysterectomy was the most powerful protective variable of relapse. Our risk predictor index was validated to identify patients at risk of recurrence.