Article Data

  • Views 693
  • Dowloads 177

Original Research

Open Access

Effect of primary radiotherapy on the survival rate of stage IVB cervical cancer patients and factors related to their survival: a real-world study based on SEER database

  • Dongmei Wang1
  • Bin Xu2
  • Donghui Lu2
  • Yu Zhang2
  • Xueqin Cai2
  • Guoping Sun1,*,

1Department of Medical Oncology, The First Affiliated Hospital of Anhui Medical University, 230031 Hefei, Anhui, China

2Department of Radiotherapy, The 901st Hospital of the Joint Logistics Support Force of PLA, 230031 Hefei, Anhui, China

DOI: 10.22514/ejgo.2023.005 Vol.44,Issue 1,February 2023 pp.42-50

Submitted: 25 June 2022 Accepted: 14 September 2022

Published: 15 February 2023

*Corresponding Author(s): Guoping Sun E-mail:


This study aimed to investigate the survival and influence factors of radiation therapy on primary tumors in patients with stage ⅣB cervical cancer. The data of 3129 stage IVB cervical cancer patients diagnosed from 2000 to 2018 in the Surveillance, Epidemiology and End Results (SEER) database were retrieved, and the propensity score matching (PSM) was used to balance variate and eliminate selection bias. The Kaplan-Meier (K-M) method was used to plot surviving profile. Univariate and multivariate analyses were used to estimate influencing factors of surviving time of stage IVB cervical cancer. After screening the SEER database, 3129 stage IVB cervical cancer patients were selected, including 2166 cases (69.2%) cases with and 963 without primary radiotherapy. PSM analysis identified 860 pairs of patients were one-to-one matched and further enrolled of radiotherapy part as well as non-radiotherapy part (control group) respectively for survival analysis. The K-M curve was compared among the two groups, and radiation therapy was found to be associated with longer survival before (Hazard ratio (HR) = 0.54,95% confidence interval (95% CI): 0.50–0.59, p < 0.001) and after (HR = 0.71, 95% CI: 0.64–0.79, p < 0.001) PSM. Multivariate Cox analysis confirmed that patients treated with radiotherapy, chemotherapy and local surgery had greater survival benefits, while high-grade tumor lesions, bone metastases, liver metastases and lung metastases were associated with significantly increased mortality. The survival rates varied among different races and were statistically different (p < 0.05). Conclusion: Primary radiotherapy could prolong the overall survival (OS) of stage IVB cervical cancer patients.


Radiotherapy; Cervical cancer; Survival rate; Stage IVB cervical cancer

Cite and Share

Dongmei Wang,Bin Xu,Donghui Lu,Yu Zhang,Xueqin Cai,Guoping Sun. Effect of primary radiotherapy on the survival rate of stage IVB cervical cancer patients and factors related to their survival: a real-world study based on SEER database. European Journal of Gynaecological Oncology. 2023. 44(1);42-50.


[1] Drolet M, Bénard É, Pérez N, Brisson M. Population level-impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Obstetrical & Gynecological Survey. 2019; 74: 590–592.

[2] Vaccarella S, Lortet-Tieulent J, Plummer M, Franceschi S, Bray F. Worldwide trends in cervical cancer incidence: impact of screening against changes in disease risk factors. European Journal of Cancer. 2013; 49: 3262–3273.

[3] Siegel RL, Miller KD, Jemal A. Cancer statisties. CA: A Cancer Journal for Clinicians. 2016; 66: 7–30.

[4] Siegel RL, Naishadham D, Jemal A. Cancer statisties. CA: A Cancer Journal for Clinicians. 2013; 63: 11–30.

[5] Li H, Wu X, Cheng X. Advances in diagnosis and treatment of metastatic cervical cancer. Journal of Gynecologic Oncology. 2016; 27: e43.

[6] Yin Z, Lou H, Tang H, Ni J, Zhou Q, Chen M. Efficacy of radical doses of pelvic radiotherapy for primary tumor treatment in patients with newly diagnosed organ metastatic cervical cancer. Radiation Oncology. 2019; 14: 82.

[7] Meir H, Kenter G, Burggraaf J, Kroep J, Welters M, Melief C, et al. The need for improvement of the treatment of advanced and metastatic cervical cancer, the rationale for combined chemo-immunotherapy. Anti-Cancer Agents in Medicinal Chemistry. 2014; 14: 190–203.

[8] Friedlander M, Grogan M. Guidelines for the treatment of recurrent and metastatic cervical cancer. The Oncologist. 2002; 7: 342–347.

[9] Chao A, Lin C, Lai C. Updates in systemic treatment for metastatic cervical cancer. Current Treatment Options in Oncology. 2014; 15: 1–13.

[10] Cibula D, Pötter R, Planchamp F, Avall-Lundqvist E, Fischerova D, Haie Meder C, et al. The European society of gynaecological oncology/european society for radiotherapy and oncology/european society of pathology guidelines for the management of patients with cervical cancer. Radiotherapy and Oncology. 2018; 127: 404–416.

[11] Serkies K, Jassem J. Systemic therapy for cervical carcinoma—current status. Chinese Journal of Cancer Research. 2018; 30: 209–221.

[12] Zanini LAG, Reis RJ, Laporte GA, Vieira SC, Zanella JF, Machado GM. Analysis of the surgical management of patients with recurrent cervical cancer after radiotherapy and chemotherapy. Journal of Brazilian College of Surgeons. 2020; 47: e20202443.

[13] Chien S, Liu C, Hu Y, Hong Y, Teng C, Yeh C, et al. Frequency of surveillance computed tomography in non-Hodgkin lymphoma and the risk of secondary primary malignancies: a nationwide population-based study. International Journal of Cancer. 2015; 137: 658–665.

[14] Nassour I, Wang SC, Christie A, Augustine MM, Porembka MR, Yopp AC, et al. Minimally invasive versus open pancreaticoduodenectomy. Annals of Surgery. 2018; 268: 151–157.

[15] Scatchard K, Forrest JL, Flubacher M, Cornes P, Williams C. Chemotherapy for metastatic and recurrent cervical cancer. The Cochrane Database of Systematic Reviews. 2012; 10: CD006469.

[16] Ning MS, Ahobila V, Jhingran A, Stecklein SR, Frumovitz M, Schmeler KM, et al. Outcomes and patterns of relapse after definitive radiation therapy for oligometastatic cervical cancer. Gynecologic Oncology. 2018; 148: 132–138.

[17] Rusthoven CG, Jones BL, Flaig TW, Crawford ED, Koshy M, Sher DJ, et al. Improved survival with prostate radiation in addition to androgen deprivation therapy for men with newly diagnosed metastatic prostate cancer. Journal of Clinical Oncology. 2016; 34: 2835–2842.

[18] Reck M, Thatcher N, Smit EF, Lorigan P, Szutowicz-Zielinska E, Liepa AM, et al. Baseline quality of life and performance status as prognostic factors in patients with extensive-stage disease small cell lung cancer treated with pemetrexed plus carboplatin vs. etoposide plus carboplatin. Lung Cancer. 2012; 78: 276–281.

[19] Kim HS, Kim T, Lee ES, Kim HJ, Chung HH, Kim JW, et al. Impact of chemoradiation on prognosis in stage IVB cervical cancer with distant lymphatic metastasis. Cancer Research and Treatment. 2013; 45: 193–201.

[20] Jeon W, Koh HK, Kim HJ, Wu H, Kim JH, Chung HH. Salvage radiotherapy for lymph node recurrence after radical surgery in cervical cancer. Journal of Gynecologic Oncology. 2012; 23: 168.

[21] Venigalla S, Guttmann DM, Horne ZD, Carmona R, Shabason JE, Beriwal S. Definitive local therapy is associated with improved overall survival in metastatic cervical cancer. Practical Radiation Oncology. 2018; 8: e377–e385.

[22] Ding L, Bi Z, Pan Z, Yu X, Zhao X, Bai S, et al. Brachytherapy-based radiotherapy is associated with improved survival for newly diagnosed metastatic cervical cancer. Brachytherapy. 2021; 20: 361–367.

[23] Perkins V, Moore K, Vesely S, Matsuo K, Mostofizadeh S, Sims TT, et al. Incorporation of whole pelvic radiation into treatment of stage IVB cervical cancer: a novel treatment strategy. Gynecologic Oncology. 2020; 156: 100–106.

[24] Comen E, Norton L, Massagué J. Clinical implications of cancer self- seeding. Nature Reviews Clinical Oncology. 2011; 8: 369–377.

[25] Danna EA, Sinha P, Gilbert M, Clements VK, Pulaski BA, Ostrand-Rosenberg S. Surgical removal of primary tumor reverses tumor-inducedimmunosuppression despite the presence of metastatic disease. Cancer Research. 2004; 64: 2205–2211.

[26] Wang Y, Farmer M, Izaguirre EW, Schwartz DL, Somer B, Tillmanns T, et al. Association of definitive pelvic radiation therapy with survival among patients with newly diagnosed metastatic cervical cancer. JAMA Oncology. 2018; 4: 1288.

[27] Huang K, Jia M, Li P, Han J, Zhang R, Li Q, et al. Radiotherapy improves the survival of patients with metastatic cervical cancer: a propensity-matched analysis of SEER database. International Journal of Gynecologic Cancer. 2018; 28: 1360–1368.

[28] Hata M, Koike I, Miyagi E, Asai-Sato M, Kaizu H, Mukai Y, et al. Radiation therapy for patients with bone metastasis from uterine cervical cancer: its role and optimal radiation regimen for palliative care. Anticancer Research. 2018; 38: 1033–1040.

[29] Shi X, Huang N- S, Shi R- L, Wei WJ, Wang YL, Ji QH. Prognostic value of primary tumor surgery in minor salivary- gland carcinoma patients with distant metastases at diagnosis: first evidence from a SEER-based study. Cancer Management and Research. 2018; 10: 2163–2172.

[30] Luo D, Liu Q, Yu W, Ma Y, Zhu J, Lian P, et al. Prognostic value of distant metastasis sites and surgery in stage IV colorectal cancer: a population-based study. International Journal of Colorectal Disease. 2018; 33: 1241–1249.

[31] Chen J, Kong Y, Weng S, Dong C, Zhu L, Yang Z, et al. Outcomes of surgery for gastric cancer with distant metastases: a retrospective study from the SEER database. Oncotarget. 2017; 8: 4342–4351.

[32] Wang Y, Ouyang Y, Su J, Bai Z, Cai Q, Cao X. Role of locoregional surgery in treating FIGO 2009 stage IVB cervical cancer patients: a population-based study. BMJ Open. 2021; 11: e042364.

[33] Saijo N. Chemotherapy against pulmonary metastasis from uterine cervical carcinoma. Gan To Kagaku Ryoho,Cancer & chemotherapy. 1982; 9: 992–997.

[34] Monk BJ, Sill MW, McMeekin DS, Cohn DE, Ramondetta LM, Boardman CH, et al. Phase III trial of four cisplatin-containing doublet combinations in stage IVB, recurrent, or persistent cervical carcinoma: a gynecologic oncology group study. Journal of Clinical Oncology. 2009; 27: 4649–4655.

[35] Kitagawa R, Katsumata N, Shibata T, Kamura T, Kasamatsu T, Nakanishi T, et al. Paclitaxel plus carboplatin versus paclitaxel plus cisplatin in metastatic or recurrent cervical cancer: the open-label randomized phase III trial JCOG0505. Journal of Clinical Oncology. 2015; 33: 2129–2135.

[36] Nishio S, Matsuo K, Yonemoto K, Shimokawa M, Hosaka M, Kodama M, et al. Race and nodal disease status are prognostic factors in patients with stage IVB cervical cancer. Oncotarget. 2018; 9: 32321–32330.

[37] Goldson A, Henschke U, Leffall LD, Schneider RL. Is there a genetic basis for the differences in cancer incidence between Afro-Americans and Euro-Americans? Journal of the National Medical Association.1981; 73: 701–706.

[38] Clegg LX, Reichman ME, Miller BA, Hankey BF, Singh GK, Lin YD, et al. Impact of socioeconomic status on cancer incidence and stage at diagnosis: selected findings from the surveillance, epidemiology, and end results: national longitudinal mortality study. Cancer Causes & Control. 2009; 20: 417–435.

[39] Somayaji D, Cloyes KG. Cancer fear and fatalism. Cancer Nursing. 2015; 38: 133–144.

[40] Collins Y, Holcomb K, Chapman-Davis E, Khabele D, Farley JH. Gynecologic cancer disparities: a report from the health disparities taskforce of the society of gynecologic oncology. Gynecologic Oncology. 2014; 133: 353–361.

[41] Jing H, Xianghong Y, Ai L, Wenjuan Z. Problems and countermeasures in the implementation of national cervical and breast screening program for women in rural areas. Chinese General Practice. 2020; 23: 1680–1686.

[42] Kavanagh K, Pollock KG, Cuschieri K, Palmer T, Cameron RL, Watt C, et al. Changes in the prevalence of human papillomavirus following a national bivalent human papillomavirus vaccination programme in Scotland: a 7-year cross-sectional study. The Lancet Infectious Diseases. 2017; 17: 1293–1302.

[43] Bruni L, Albero G, Serrano B, Mena M, Collado JJ, Gómez D, et al. ICO/IARC information centre on HPV and cancer (HPV information centre). Human Papillomavirus and Related Diseases in China. 2019; 17: 23-25.

[44] Cohen PA, Jhingran A, Oaknin A, Denny L. Cervical cancer. The Lancet. 2019; 393: 169–182.

[45] Sasano T, Mabuchi S, Kuroda H, Takahashi R, Kozasa K, Isohashi F, et al. Predictors of survival in patients with FIGO stage IVB cervical cancer. International Journal of Gynecological Cancer. 2016; 26: 528–533.

[46] Usami T, Takahashi A, Matoda M, Okamoto S, Kondo E, Kanao H, et al. Review of treatment and prognosis of stage IVB cervical carcinoma. International Journal of Gynecologic Cancer. 2016; 26: 1239–1245.

[47] Small W, Bacon MA, Bajaj A, Chuang LT, Fisher BJ, Harkenrider MM, et al. Cervical cancer: a global health crisis. Cancer. 2017; 123: 2404–2412.

[48] Lim MC, Lee H, Seo S, Kim MS, Kim J, Zo JI, et al. Pathologic diagnosis and resection of suspicious thoracic metastases in patients with cervical cancer through thoracotomy or video-assisted thoracic surgery. Gynecologic Oncology. 2010; 116: 478–482.

[49] Seki M, Nakagawa K, Tsuchiya S, Matsubara T, Kinoshita I, Weng S, et al. Surgical treatment of pulmonary metastases from uterine cervical cancer. The Journal of Thoracic and Cardiovascular Surgery. 1992; 104: 876–881.

[50] Emmett M, Gildea C, Nordin A, Hirschowitz L, Poole J. Cervical cancer—does the morphological subtype affect survival rates? Journal of Obstetrics and Gynaecology. 2018; 38: 548–555.

[51] González Casaurrán G, Simón Adiego C, Peñalver Pascual R, Moreno Mata N, Lozano Barriuso MÁ, González Aragoneses F. Surgery of female genital tract tumour lung metastases. Archivos de Bronconeumología. 2011; 47: 134–137.

[52] Hwang JH, Yoo HJ, Lim MC, Seo S, Kang S, Kim J, et al. Brain metastasis in patients with uterine cervical cancer. Journal of Obstetrics and Gynaecology Research. 2013; 39: 287–291.

[53] Matsumiya H, Todo Y, Okamoto K, Takeshita S, Yamazaki H, Yamashiro K, et al. A prediction model of survival for patients with bone metastasis from uterine cervical cancer. Journal of Gynecologic Oncology. 2016; 27: e55.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time