Heterogeneous treatment effects of adjuvant therapy for patients with cervical cancer in the intermediate‐risk group
Abstract Background The efficacy of adjuvant therapy for patients with cervical cancer with intermediate risk (CC‐IR) remains controversial. We examined the impact of adjuvant therapy on survival outcomes in patients with CC‐IR and evaluated the heterogeneous treatment effects (HTEs) of adjuvant the...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-09-01
|
| Series: | Cancer Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cam4.6460 |
| _version_ | 1797361295703408640 |
|---|---|
| author | Ayumi Taguchi Kosuke Kato Konan Hara Akiko Furusawa Yujiro Nakajima Chihiro Ishizawa Michihiro Tanikawa Kenbun Sone Mayuyo Mori Muneaki Shimada Aikou Okamoto Munetaka Takekuma |
| author_facet | Ayumi Taguchi Kosuke Kato Konan Hara Akiko Furusawa Yujiro Nakajima Chihiro Ishizawa Michihiro Tanikawa Kenbun Sone Mayuyo Mori Muneaki Shimada Aikou Okamoto Munetaka Takekuma |
| author_sort | Ayumi Taguchi |
| collection | DOAJ |
| description | Abstract Background The efficacy of adjuvant therapy for patients with cervical cancer with intermediate risk (CC‐IR) remains controversial. We examined the impact of adjuvant therapy on survival outcomes in patients with CC‐IR and evaluated the heterogeneous treatment effects (HTEs) of adjuvant therapies based on clinicopathologic characteristics. Methods We retrospectively analyzed a previous Japanese nationwide cohort of 6192 patients with stage IB–IIB cervical cancer who underwent radical hysterectomy. We created two pairs of propensity score‐matched treatment/control groups to investigate the treatment effects of adjuvant therapies: (1) adjuvant therapy versus non‐adjuvant therapy; (2) chemotherapy versus radiotherapy conditional on adjuvant therapy. Multivariate analyses with treatment interactions were performed to evaluate the HTEs. Results Among the 1613 patients with CC‐IR, 619 and 994 were in the non‐treatment and treatment groups, respectively. Survival outcomes did not differ between the two groups: 3‐year progression‐free survival (PFS) rates were 88.1% and 90.3% in the non‐treatment and treatment groups, respectively (p = 0.199). Of the patients in the treatment group, 654 and 340 received radiotherapy and chemotherapy, respectively. Patients who received chemotherapy had better PFS than those who received radiotherapy (3‐year PFS, 90.9% vs. 82.9%, p = 0.010). Tumor size was a significant factor that affected the treatment effects of chemotherapy; patients with large tumors gained better therapeutic effects from chemotherapy than those with small tumors. Conclusion Adjuvant therapy is optional for some patients with CC‐IR; however, chemotherapy can be recommended as adjuvant therapy, particularly for patients with large tumors. |
| first_indexed | 2024-03-08T15:51:49Z |
| format | Article |
| id | doaj.art-8c06521207824fce94f86ed19d206121 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-03-08T15:51:49Z |
| publishDate | 2023-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-8c06521207824fce94f86ed19d2061212024-01-09T05:21:15ZengWileyCancer Medicine2045-76342023-09-011218185571856710.1002/cam4.6460Heterogeneous treatment effects of adjuvant therapy for patients with cervical cancer in the intermediate‐risk groupAyumi Taguchi0Kosuke Kato1Konan Hara2Akiko Furusawa3Yujiro Nakajima4Chihiro Ishizawa5Michihiro Tanikawa6Kenbun Sone7Mayuyo Mori8Muneaki Shimada9Aikou Okamoto10Munetaka Takekuma11Department of Obstetrics and Gynecology, Graduate School of Medicine The University of Tokyo Tokyo JapanDepartment of Obstetrics and Gynecology, Graduate School of Medicine The University of Tokyo Tokyo JapanDepartment of Economics University of Arizona Tucson Arizona USAGynecology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo JapanDepartment of Radiological Sciences Komazawa University Tokyo JapanDepartment of Obstetrics and Gynecology, Graduate School of Medicine The University of Tokyo Tokyo JapanDepartment of Obstetrics and Gynecology, Graduate School of Medicine The University of Tokyo Tokyo JapanDepartment of Obstetrics and Gynecology, Graduate School of Medicine The University of Tokyo Tokyo JapanDepartment of Obstetrics and Gynecology, Graduate School of Medicine The University of Tokyo Tokyo JapanDepartment of Obstetrics and Gynecology Tohoku University School of Medicine Sendai JapanDepartment of Obstetrics and Gynecology The Jikei University School of Medicine Tokyo JapanDepartment of Gynecology Shizuoka Cancer Center Hospital Shizuoka JapanAbstract Background The efficacy of adjuvant therapy for patients with cervical cancer with intermediate risk (CC‐IR) remains controversial. We examined the impact of adjuvant therapy on survival outcomes in patients with CC‐IR and evaluated the heterogeneous treatment effects (HTEs) of adjuvant therapies based on clinicopathologic characteristics. Methods We retrospectively analyzed a previous Japanese nationwide cohort of 6192 patients with stage IB–IIB cervical cancer who underwent radical hysterectomy. We created two pairs of propensity score‐matched treatment/control groups to investigate the treatment effects of adjuvant therapies: (1) adjuvant therapy versus non‐adjuvant therapy; (2) chemotherapy versus radiotherapy conditional on adjuvant therapy. Multivariate analyses with treatment interactions were performed to evaluate the HTEs. Results Among the 1613 patients with CC‐IR, 619 and 994 were in the non‐treatment and treatment groups, respectively. Survival outcomes did not differ between the two groups: 3‐year progression‐free survival (PFS) rates were 88.1% and 90.3% in the non‐treatment and treatment groups, respectively (p = 0.199). Of the patients in the treatment group, 654 and 340 received radiotherapy and chemotherapy, respectively. Patients who received chemotherapy had better PFS than those who received radiotherapy (3‐year PFS, 90.9% vs. 82.9%, p = 0.010). Tumor size was a significant factor that affected the treatment effects of chemotherapy; patients with large tumors gained better therapeutic effects from chemotherapy than those with small tumors. Conclusion Adjuvant therapy is optional for some patients with CC‐IR; however, chemotherapy can be recommended as adjuvant therapy, particularly for patients with large tumors.https://doi.org/10.1002/cam4.6460adjuvant chemotherapyadjuvant radiotherapycervical cancercohort studiespropensity scoretreatment outcome |
| spellingShingle | Ayumi Taguchi Kosuke Kato Konan Hara Akiko Furusawa Yujiro Nakajima Chihiro Ishizawa Michihiro Tanikawa Kenbun Sone Mayuyo Mori Muneaki Shimada Aikou Okamoto Munetaka Takekuma Heterogeneous treatment effects of adjuvant therapy for patients with cervical cancer in the intermediate‐risk group Cancer Medicine adjuvant chemotherapy adjuvant radiotherapy cervical cancer cohort studies propensity score treatment outcome |
| title | Heterogeneous treatment effects of adjuvant therapy for patients with cervical cancer in the intermediate‐risk group |
| title_full | Heterogeneous treatment effects of adjuvant therapy for patients with cervical cancer in the intermediate‐risk group |
| title_fullStr | Heterogeneous treatment effects of adjuvant therapy for patients with cervical cancer in the intermediate‐risk group |
| title_full_unstemmed | Heterogeneous treatment effects of adjuvant therapy for patients with cervical cancer in the intermediate‐risk group |
| title_short | Heterogeneous treatment effects of adjuvant therapy for patients with cervical cancer in the intermediate‐risk group |
| title_sort | heterogeneous treatment effects of adjuvant therapy for patients with cervical cancer in the intermediate risk group |
| topic | adjuvant chemotherapy adjuvant radiotherapy cervical cancer cohort studies propensity score treatment outcome |
| url | https://doi.org/10.1002/cam4.6460 |
| work_keys_str_mv | AT ayumitaguchi heterogeneoustreatmenteffectsofadjuvanttherapyforpatientswithcervicalcancerintheintermediateriskgroup AT kosukekato heterogeneoustreatmenteffectsofadjuvanttherapyforpatientswithcervicalcancerintheintermediateriskgroup AT konanhara heterogeneoustreatmenteffectsofadjuvanttherapyforpatientswithcervicalcancerintheintermediateriskgroup AT akikofurusawa heterogeneoustreatmenteffectsofadjuvanttherapyforpatientswithcervicalcancerintheintermediateriskgroup AT yujironakajima heterogeneoustreatmenteffectsofadjuvanttherapyforpatientswithcervicalcancerintheintermediateriskgroup AT chihiroishizawa heterogeneoustreatmenteffectsofadjuvanttherapyforpatientswithcervicalcancerintheintermediateriskgroup AT michihirotanikawa heterogeneoustreatmenteffectsofadjuvanttherapyforpatientswithcervicalcancerintheintermediateriskgroup AT kenbunsone heterogeneoustreatmenteffectsofadjuvanttherapyforpatientswithcervicalcancerintheintermediateriskgroup AT mayuyomori heterogeneoustreatmenteffectsofadjuvanttherapyforpatientswithcervicalcancerintheintermediateriskgroup AT muneakishimada heterogeneoustreatmenteffectsofadjuvanttherapyforpatientswithcervicalcancerintheintermediateriskgroup AT aikouokamoto heterogeneoustreatmenteffectsofadjuvanttherapyforpatientswithcervicalcancerintheintermediateriskgroup AT munetakatakekuma heterogeneoustreatmenteffectsofadjuvanttherapyforpatientswithcervicalcancerintheintermediateriskgroup |