Abstract / Summary
Abstract Background Cervical cancer remains a major global health burden despite high cure rates in early-stage disease. A substantial proportion of patients still develop recurrence within the first years after primary treatment. Recurrence patterns and their impact on survival remain incompletely characterized across FIGO stages. Objective To characterize recurrence patterns and treatment strategies in patients with recurrent cervical cancer, and to evaluate their impact on recurrence-free survival and overall survival after recurrence across FIGO stages. Methods This retrospective cohort study was conducted at a multidisciplinary gynecologic tumor center in Frankfurt, Germany. Patients discussed at the tumor board between January 2016 and December 2023 were screened, and patients with recurrent cervical cancer were followed through December 2025. Time from primary treatment to recurrence and post-recurrence overall survival were analyzed using Kaplan–Meier methods and log-rank tests. Univariable and multivariable Cox proportional hazards regression analyses were performed to identify factors associated with post-recurrence survival. Results Fifty-nine patients with recurrent cervical cancer were included. The median time to recurrence was 23 months (IQR, 12.5–45). Post-recurrence survival differed significantly by FIGO stage (log-rank p = 0.02), with 2-year survival of 57.4% in stage I and 0% in stage IV disease. In univariable Cox regression, higher FIGO stage was associated with increased mortality after recurrence (HR 1.373, 95% CI 1.022–1.844; p = 0.035), remaining significant after adjustment for tumor grade (HR 1.414, 95% CI 1.065–1.877; p = 0.016). Tumor grade was not independently associated with survival. Recurrence site showed a trend toward association with FIGO stage (p = 0.07), with more extrapelvic recurrences in advanced-stage disease. Adnexal management was associated with recurrence site (p = 0.03); extrapelvic recurrence occurred in 76.5% of patients undergoing ovariopexy. Neither ovariopexy nor salpingo-oophorectomy was associated with post-recurrence survival Conclusions Initial FIGO stage was independently associated with survival after cervical cancer recurrence, with advanced-stage disease associated with poorer post-recurrence outcomes. Adnexal management was associated with recurrence pattern but not with survival after recurrence. These findings highlight the prognostic importance of initial disease extent and support individualized surveillance and counseling in patients at risk of recurrence. Larger multicenter studies are warranted to clarify the prognostic role of recurrence timing, recurrence site, and adnexal management.