SUCCOR Risk: Design and Validation of a Recurrence Prediction Index for Early-Stage Cervical Cancer
Authors: Manzour Nabil , Chiva Luis , Chacón Enrique , Martin-Calvo Nerea , Boria Felix , Minguez José A. , Alcazar Juan L. ,   On behalf of the SUCCOR Study Group, Zanagnolo Vanna , Querleu Denis , Căpîlna Mihai , Fagotti Anna , Kucukmetin Ali , Mom Constantijne , Chakalova Galina , Aliyev Shamistan , Malzoni Mario , Narducci Fabrice , Arencibia Octavio , Raspagliesi Francesci , Toptas Tayfun , Cibula David , Kaidarova Dilyara , Meydanli Mehmet , Tavares Mariana , Golub Dmytro , Perrone Anna , Poka Robert , Tsolakidis Dimitrios , Vujić Goran , Jedryka Marcin , Zusterzeel Petra , Beltman Jogchum , Goffin Frédéric , Haidopoulos Dimitros , Haller Herman , Jach Robert , Yezhova Iryna , Berlev Igor , Bernardino Margarida , Bharathan Rasiah , Lanner Maximilian , Sukhin Vladyslav , Feron Jean G. , Fruscio Robert , Kukk Kersti , Ponce Jordi , Abdalla Nabil , Akbayir Özgür , Akgöl Sedat , Aksahin Elif , Aliyev Shamistan , Alonso-Espias Maria , Aluloski Igor , Andrade Claudia , Badzakov Nikola , Barrachina Rosa , Bogani Giorgio , Bonci Eduard-Aexandru , Bonsang-Kitzis Hélène , Brucker Cosima , Cárdenas Laura , Casajuana Andrea , Cavalle Pere , Cea Jorge , Chiofalo Benito , Cordeiro Gloria , Coronado Pluvio , Cuadra Maria , Díez Javier , da Costa Teresa Diniz , Domingo Santiago , Dostalek Lukas , Demirkiran Fuat , Erasun Diego , Fehr Mathias , Fernandez-Gonzalez Sergi , Fidalgo Soledad , Fiol Gabriel , Galaal Khadra , García José , Gebauer Gerhard , Ghezzi Fabio , Gilabert Juan , Gomes Nana , Gonçalves Elisabete , Gonzalez Virginia , Grandjean Frederic , Guijarro Miriam , Guyon Frédéric , Haesen Jolien , Hernandez-Cortes Gines , Herrero Sofía , Pete Imre , Kalogiannidis Ioannis , Karaman Erbil , Kavallaris Andreas , Klasa Lukasz , Kotsopoulos Ioannis , Kovachev Stefan , Leht Meelis , Lekuona Arantxa , Luyckx Mathieu , Mallmann Michael , Mancebo Gemma , Mandic Aljosa , Marina Tiermes , Martin Victor , Martín-Salamanca María Belén , Martinez Alejandra , Meili Gesine , Mendinhos Gustavo , Mereu Liliana , Mitrovic Milena , Morales Sara , Moratalla Enrique , Morillas Bibiana , Myriokefalitaki Eva , PakižImre Maja , Petousis Stamatios , Pirtea Laurentiu , Povolotskaya Natalia , Prader Sonia , Quesada Alfonso , Redecha Mikuláš , Roldan Fernando , Rolland Philip , Saaron Reeli , Sarac Cosmin-Paul , Scharf Jens-Peter , Smrkolj Špela , Sousa Rita , Stepanyan Artem , Študent Vladimír , Tauste Carmen , Trum Hans , Turan Taner , Undurraga Manuela , Uppin Arno , Vázquez Alicia , Vergote Ignace , Vorgias George , Zapardiel Ignacio 
Published: April 2022

Abstract
Objective
Based on the SUCCOR study database, our primary objective was to identify the independent clinical pathological variables associated with the risk of relapse in patients with stage IB1 cervical cancer who underwent a radical hysterectomy. Our secondary goal was to design and validate a risk predictive index (RPI) for classifying patients depending on the risk of recurrence.

Methods
Overall, 1116 women were included from January 2013 to December 2014. We randomly divided our sample into two cohorts: discovery and validation cohorts. The test group was used to identify the independent variables associated with relapse, and with these variables, we designed our RPI. The index was applied to calculate a relapse risk score for each participant in the validation group.

Results
A previous cone biopsy was the most significant independent variable that lowered the rate of relapse (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.17–0.60). Additionally, patients with a tumor diameter >2 cm on preoperative imaging assessment (OR 2.15, 95% CI 1.33–3.5) and operated by the minimally invasive approach (OR 1.61, 95% CI 1.00–2.57) were more likely to have a recurrence. Based on these findings, patients in the validation cohort were classified according to the RPI of low, medium, or high risk of relapse, with rates of 3.4%, 9.8%, and 21.3% observed in each group, respectively. With a median follow-up of 58 months, the 5-year disease-free survival rates were 97.2% for the low-risk group, 88.0% for the medium-risk group, and 80.5% for the high-risk group (p < 0.001).

Conclusion
Previous conization to radical hysterectomy was the most powerful protective variable of relapse. Our risk predictor index was validated to identify patients at risk of recurrence.