Cervical cancer recurrence: Proposal for a classification based on anatomical dissemination pathways and prognosis.

INTRODUCTION: Precise definitions of recurrences and optimal treatment strategy are yet to be clearly defined among patients with cervical cancer (CC). The purpose of this study was to develop a reproducible classification of CC recurrence. MATERIEL AND METHODS: Data of women with FIGO stages I-IV CC treated between January 2000 and January 2015 were retrospectively abstracted from nine French institutions. We proposed a rTNM classification for recurrence: locoregional (rT), nodal (rN), or distant organ (rM). According to rTNM prognosis, we then defined a rSTAGE classification (I, II, IIIA, IIIB, IVA, IVB). RESULTS: Among the 1028 women treated for FIGO stages I-IV CC during the study period, 216 recurrences were observed (21%). The 3-year survival after recurrence was 38.8%, with a median time to recurrence of 9 months (95% CI, 30.9-48.7). A trend for a lower 3-year survival after recurrence was observed in women with multiple-site vs single-site recurrence (p = 0.1). Among the women in the rT group, a difference in 3-year survival after recurrence was found between rT1 single site, rT2 single site and rT3 single site (p = 0.02). The 3-year survival after recurrence was 69.1%, 49.2%, 37.5%, 34.2%, 23.1% and 24.4% for rStage I, II, IIIA, IIIB, IVA and IVB, respectively (p = 0.007). CONCLUSION: rTNM classifications and rSTAGE are discriminatory and allow all recurrence modalities to be classified.