Risk of recurrence, prognosis, and follow‐up for Danish women with cervical cancer in 2005‐2013: A national cohort study

BACKGROUND In developed countries, women attend follow‐up after treatment for cervical cancer to detect recurrence. The aim of this study was to describe the Danish population of women with early‐stage cervical cancer at risk for recurrence and death due to recurrence. METHODS Data were extracted from 3 nationwide databases to find women diagnosed with stage 1A1 to 1B1 cervical cancer in 2005‐2013. Recurrences were determined from data on oncological or surgical treatment more than 3 months after the initial diagnosis and were cross‐checked with patient journals. RESULTS In all, 1523 patients were diagnosed with stage 1A1 to 1B1 cervical cancer. Eighty women experienced recurrences: 8 at International Federation of Gynecology and Obstetrics (FIGO) stage 1A1, 0 at FIGO stage 1A2, and 72 at FIGO stage 1B1. The 5‐year recurrence rate was 6.4%; 67.5% of the women had symptomatic recurrences, and 28.8% had asymptomatic recurrences. At significantly greater risk for recurrence were women at stage 1B1, regardless of their lymph node (LN) status at diagnosis (hazard ratio with a positive LN, 5.10; 95% confidence interval [CI], 1.65‐15.76; P = .0047; hazard ratio with a negative LN, 3.14; 95% CI, 1.25‐7.93; P = .0153; hazard ratio with LN data missing, 6.33; 95% CI, 1.80‐22.26; P = .004), women older than 50 years (hazard ratio, 1.81; 95% CI, 1.12‐2.94; P = .0158), and women with lymphatic and lymphovascular space invasion (LVSI; hazard ratio, 1.92; 95% CI, 1.11‐3.30; P = .0188). In a multivariate analysis, significantly inferior survival was found after recurrence for patients with lymphatic LVSI (hazard ratio, 2.23; 95% CI, 1.04‐4.80; P = .0401), a symptomatic diagnosis of recurrence (hazard ratio, 2.52; 95% CI, 1.08‐5.90; P = .0332), and multiple sites of recurrence (hazard ratio, 2.72; 95% CI, 1.32‐5.61; P = .0066). CONCLUSIONS This study has identified a group of women at FIGO stage 1A1 in no need of specialized, hospital‐based follow‐up. Many of the recurrences at FIGO stage 1B1 are asymptomatic, and this may show a need for follow‐up in this group. Further prospective investigation is needed. Cancer 2018;124:943‐51. © 2017 American Cancer Society. Women with stage 1B1 cervical cancer who are older than 50 years or have lymphovascular space invasion at the initial diagnosis are at risk for recurrence. Subsequently, women with lymphovascular space invasion at the initial diagnosis, a symptomatic diagnosis of recurrence, or multiple sites of recurrence are at g