Prognostic factors of locally advanced cervical cancer after concurrent chemoradiotherapy

Objective To investigate the prognostic value of magnetic resonance imaging (MRI) and clinical features in locally advanced cervical cancer (LACC) after concurrent chemoradiotherapy (CCRT). Method This study recruited 189 patients with LACC who received definitive CCRT between May 2018 and December 2020 and underwent MRI, including diffusion-weighted imaging, before and 1 month after initial therapy. The tumor size and mean apparent diffusion coefficient (ADC _mean ) values were evaluated. A Cox proportional hazards model was used to determine the association of clinical characteristics and imaging factors with progression-free survival (PFS) and overall survival (OS) based on univariate and multivariate analysis. Result The median follow-up time was 58 (range: 11–71) months. The 5-year PFS and OS rates were 73.8% and 85.5%, respectively. Univariate analysis revealed that serum squamous cell carcinoma (SCC) antigen level, stage, Pre-treatment tumor size, residual disease (RD) and post-treament ADC _mean values were significant predictors of PFS and OS. Positive pelvic lymph node and adjuvant chemotherapy after CCRT were adverse predictors of PFS and OS, respectively. Multivariate analysis revealed that stage, SCC antigen level, and RD were independent predictors of PFS (hazard ratio [HR] = 3.282, P  < 0.001; HR = 2.567, P  = 0.002; and HR = 1.621, P  < 0.001, respectively) and OS (HR = 2.517, P  = 0.043; HR = 1.025, P  = 0.015; and HR = 1.712, P  = 0.008, respectively). Based on the threshold, RD size ≥ 1.1 cm resulted in a considerably worse PFS and OS. Conclusion Elevated SCC antigen level, advanced stage, and RD size ≥ 1.1 cm were linked to worse PFS and OS. Furthermore, the ADC _mean values was not a reliable predictor of survival outcomes.