Introduction
Materials and methods
Study design
Statistical analysis
Results
Demographic and clinical characteristics for liver metastasis
Subject characteristics | No. of cervical cancer patients (2010–2015) | χ2 | P-value | |
---|---|---|---|---|
With LM (N = 431, 2.32%) | Without LM (N = 18,127, 97.68%) | |||
Age in years | 68.154 | < 0.001 | ||
18–40 | 55 (12.8%) | 5320 (28%) | ||
41–64 | 244 (56.6%) | 10,125 (53.3%) | ||
≥ 65 | 132 (30.6%) | 3544 (18.7%) | ||
Year of diagnosis | 3.63 | 0.163 | ||
2010–2011 | 124 (28.8%) | 6292 (33.1%) | ||
2012–2013 | 149 (32.6%) | 6175 (32.5%) | ||
2014–2015 | 158 (36.7%) | 6522 (34.35) | ||
Race | 17.867 | 0.001 | ||
White | 296 (68.7%) | 14,170 (74.6%) | ||
Black | 88 (20.4%) | 2620 (13.8%) | ||
Others | 46 (10.7%) | 2005 (10.6%) | ||
Unknown | 1 (0.2%) | 194 (1.0%) | ||
Marital status | 1.183 | 0.553 | ||
Married | 263 (61.0%) | 12,062 (63.5%) | ||
Unmarried | 138 (32.0%) | 5733 (30.2%) | ||
Unknown | 30 (7.0%) | 1194 (6.3%) | ||
Insurance | 6.827 | 0.033 | ||
Insured | 380 (88.2%) | 17,242 (90.8%) | ||
Uninsured | 41 (9.5%) | 1220 (6.4%) | ||
Unknown | 10 (2.3%) | 527 (2.8%) | ||
Primary Site | 20.689 | < 0.001 | ||
Endocervix | 48 (11.1%) | 3590 (18.9%) | ||
Exocervix | 3 (0.7%) | 341 (1.8%) | ||
Overlapping lesion of cervix | 7 (1.6%) | 304 (1.6%) | ||
Cervix uteri, unspecified | 373 (86.5%) | 14,754 (77.7%) | ||
AJCC stage | ||||
T stage | 169.341 | < 0.001 | ||
T1 | 59 (13.7%) | 10,397 (54.8%) | ||
T2 | 73 (16.9%) | 4170 (22.0%) | ||
T3 | 144 (33.4%) | 2911 (15.3%) | ||
T4 | 61 (14.2%) | 671 (3.5%) | ||
Unknown | 94 (21.8%) | 840 (4.4%) | ||
N stage | 468.148 | < 0.001 | ||
N0 | 124 (28.8%) | 13,554 (71.4%) | ||
N1 | 218 (50.6%) | 4622 (24.3%) | ||
Unknown | 89 (20.6%) | 813 (4.3%) | ||
Grade | 615.394 | < 0.001 | ||
I | 4 (0.9%) | 2141 (11.3%) | ||
II | 54 (12.5%) | 5940 (31.3%) | ||
III | 175 (40.6%) | 5353 (28.2%) | ||
IV | 28 (6.5%) | 417 (2.2%) | ||
Unknown | 170 (39.4%) | 5138 (27.1%) | ||
Histology | 132.849 | < 0.001 | ||
SCC | 207 (48.0%) | 12,429 (65.5%) | ||
AC | 97 (22.5%) | 4366 (23.05) | ||
Others | 127 (29.5%) | 2194 (11.6%) | ||
Tumor size | 152.343 | < 0.001 | ||
≤ 2 cm | 12 (2.8%) | 4168 (21.9%) | ||
> 2, ≤4 cm | 31 (7.2%) | 3031 (16.0%) | ||
> 4 cm | 140 (39.4%) | 5861 (30.9%) | ||
Unknown | 218 (50.6%) | 5929 (31.2%) | ||
Surgery primary site | 365.563 | < 0.001 | ||
Yes | 386 (89.6%) | 8243 (43.4%) | ||
No | 45 (10.4%) | 10,712 (56.4%) | ||
Unknown | 0 (0.0%) | 34 (0.2%) | ||
Lung Met | 2397.509 | < 0.001 | ||
No | 204 (47.3%) | 18,331 (96.5%) | ||
Yes | 204 (47.3%) | 622 (3.3%) | ||
Unknown | 23 (5.3%) | 36 (0.2%) | ||
Bone Met | 1723.957 | < 0.001 | ||
No | 286 (66.4%) | 18,634 (98.1%) | ||
Yes | 128 (29.7%) | 330 (1.7%) | ||
Unknown | 17 (3.9%) | 25 (0.1%) | ||
Brain Met | 685.061 | < 0.001 | ||
No | 391 (90.7%) | 18,911 (99.6%) | ||
Yes | 18 (4.2%) | 61 (0.3%) | ||
Unknown | 22 (5.1%) | 17 (0.1%) | ||
Radiotherapy | 8.924 | 0.003 | ||
Yes | 206 (47.8%) | 10,451 (55.0%) | ||
No/ Unknown | 225 (52.2%) | 8538 (45.0%) | ||
Chemotherapy | 22.572 | < 0.001 | ||
Yes | 263 (61.0%) | 9390 (49.4%) | ||
No/Unknown | 168 (39.0%) | 9599 (50.6%) | ||
Status (%) | 773.048 | < 0.001 | ||
Alive | 37 (8.6%) | 13,467 (70.9%) | ||
Dead | 394 (91.4%) | 5522 (29.1) | ||
Median survival time(IQR) | 5 (2–11) | 29 (14–52) |
Associated risk factors for developing liver metastasis
Subject characteristics | Univariate analysis | Multivariate analysis | ||
---|---|---|---|---|
OR (95% CI) | P-value | OR (95% CI) | P-value | |
Age in years | ||||
18–40 | Ref | 1.00 | Ref | 1.00 |
41–64 | 2.331 (1.736–3.129) | < 0.001 | 1.071 (0.772–1.486) | 0.681 |
≥ 65 | 3.603 (2.623–4.949) | < 0.001 | 1.105 (0.770–1.586) | 0.587 |
Race | ||||
White | Ref | 1.00 | Ref | 1.00 |
Black | 1.608 (1.263–2.047) | < 0.001 | 1.469 (1.118–1.932) | 0.006 |
Others | 1.098 (0.802–1.504) | 0.559 | 1.088 (0.757–1.565) | 0.648 |
Unknown | NA | NA | NA | NA |
Insurance | ||||
Insured | Ref | 1.00 | Ref | 1.00 |
Uninsured | 1.525 (1.099–2.115) | 0.012 | 1.632 (1.124–2.368) | 0.010 |
Unknown | NA | NA | NA | NA |
T stage | ||||
T1 | Ref | 1.00 | Ref | 1.00 |
T2 | 3.085 (2.185–4.356) | < 0.001 | 1.216 (0.827–1.789) | 0.320 |
T3 | 8.717 (6.421–11.835) | < 0.001 | 1.703 (1.179–2.460) | 0.005 |
T4 | 16.020 (11.107–23.107) | < 0.001 | 2.699 (1.741–4.185) | < 0.001 |
Unknown | NA | NA | NA | NA |
N stage | ||||
N0 | Ref | 1.00 | Ref | 1.00 |
N1 | 5.156 (4.125–6.443) | < 0.001 | 1.650 (1.274–2.138) | < 0.001 |
Unknown | NA | NA | NA | NA |
Grade | ||||
I | Ref | 1.00 | Ref | 1.00 |
II | 4.866 (1.760–13.451) | 0.002 | 3.127 (1.094–8.935) | 0.033 |
III | 17.498 (6.486–47.205) | < 0.001 | 5.509 (1.960–15.417) | 0.001 |
IV | 35.940 (12.541–103.001) | < 0.001 | 7.639 (2.503–23.311) | < 0.001 |
Unknown | NA | NA | NA | NA |
Histology | ||||
SCC | Ref | 1.00 | Ref | 1.00 |
AC | 1.334 (1.046–1.702) | 0.002 | 2.052 (1.544–2.727) | < 0.001 |
Others | 3.476 (2.774–4.355) | < 0.001 | 2.262 (1.716–2.982) | < 0.001 |
Tumor size | ||||
≤ 2 cm | Ref | 1.00 | Ref | 1.00 |
> 2, ≤4 cm | 3.552 (1.821–6.928) | < 0.001 | 1.564 (0.764–3.202) | 0.221 |
> 4 cm | 10.075 (5.603–18.116) | < 0.001 | 1.601 (0.834–3.071) | 0.157 |
Unknown | NA | NA | NA | NA |
Surgery primary site | ||||
No | Ref | 1.00 | Ref | 1.00 |
yes | 0.090 (0.066–0.122) | < 0.001 | 0.341 (0.235–0.493) | < 0.001 |
Unknown | NA | NA | NA | NA |
Lung Met | ||||
No | Ref | 1.00 | Ref | 1.00 |
Yes | 29.471 (23.892–36.353) | < 0.001 | 7.272 (5.687–9.299) | < 0.001 |
Unknown | NA | NA | NA | NA |
Bone Met | ||||
No | Ref | 1.00 | Ref | 1.00 |
Yes | 25.272 (19.976–31.971) | < 0.001 | 4.875 (3.679–6.460) | < 0.001 |
Unknown | NA | NA | NA | NA |
Brain Met | ||||
No | Ref | 1.00 | Ref | 1.00 |
Yes | 14.272 (8.357–24.373) | < 0.001 | 4.655 (1.770–12.245) | 0.002 |
Unknown | NA | NA | NA | NA |
Cox proportional hazards regression analysis
Subject characteristics | Univariable | Multivariable | ||
---|---|---|---|---|
HR (95% CI) | P-value | HR (95% CI) | P-value | |
Age in years | ||||
18–40 | Ref | 1.00 | Ref | 1.00 |
41–64 | 1.244 (0.910–1.699) | 0.171 | 1.207 (0.872–1.672) | 0.257 |
≥ 65 | 1.402 (1.002–1.961) | 0.048 | 1.253 (0.886–1.771) | 0.202 |
Surgery primary site | ||||
No | Ref | 1.00 | Ref | 1.00 |
yes | 0.668 (0.481–0.927) | 0.016 | 0.716 (0.506–1.012) | 0.058 |
Lung Met | ||||
No | Ref | 1.00 | Ref | 1.00 |
Yes | 1.384 (1.128–1.698) | 0.002 | 1.451 (1.175–1.793) | 0.001 |
Bone Met | ||||
No | Ref | 1.00 | Ref | 1.00 |
Yes | 1.244 (1.000–1.549) | 0.050 | 1.160 (0.929–1.448) | 0.190 |
Radiotherapy | ||||
Yes | Ref | 1.00 | Ref | 1.00 |
No/ Unknown | 1.583 (1.297–1.933) | < 0.001 | 1.555 (1.262–1.915) | < 0.001 |
Chemotherapy | ||||
Yes | Ref | 1.00 | Ref | 1.00 |
No/Unknown | 3.390 (2.738–4.198) | < 0.001 | 3.312 (2.654–4.134) | < 0.001 |
Subject characteristics | Univariable | Multivariable | ||
---|---|---|---|---|
HR (95% CI) | P-value | HR (95% CI) | P-value | |
Age in years | ||||
18–40 | Ref | 1.00 | Ref | 1.00 |
41–64 | 1.311 (0.945–1.817) | 0.105 | 1.189 (0.845–1.673) | 0.321 |
≥ 65 | 1.373 (0.959–1.966) | 0.083 | 1.128 (0.780–1.633) | 0.522 |
Surgery primary site | ||||
No | Ref | 1.00 | Ref | 1.00 |
yes | 0.687 (0.474–0.994) | 0.046 | 0.821 (0.557–1.210) | 0.319 |
Lung Met | ||||
No | Ref | 1.00 | Ref | 1.00 |
Yes | 1.416 (1.136–1.765) | 0.002 | 1.471 (1.171–1.847) | 0.001 |
Bone Met | ||||
No | Ref | 1.00 | Ref | 1.00 |
Yes | 1.240 (0.982–1.564) | 0.070 | 1.114 (0.880–1.410) | 0.370 |
Chemotherapy | ||||
Yes | Ref | 1.00 | Ref | 1.00 |
No/Unknown | 3.117 (2.475–3.924) | < 0.001 | 3.229 (2.551–4.086) | < 0.001 |