The risk factors and patterns for distant metastasis in early-stage cervical adenocarcinoma patients receiving radical surgery and adjuvant radiotherapy: the ATTRACT study.

Background: Cervical adenocarcinoma (ADC) accounts for 15-25% of cervical cancer cases and carries a higher risk of distant metastasis (DM) and a poorer prognosis than squamous cell carcinoma (SCC). However, the DM patterns and risk factors in ADC patients receiving radical surgery and postoperative radiotherapy (PORT) remain insufficiently characterized. This study aimed to explore the DM pattern and risk factors associated with DM in ADC patients receiving radical surgery and postoperative radiotherapy. Methods: Patients with pathologically confirmed ADC after radical surgery were selected. The DM pattern was described using a metastatic organ distribution map. Survival outcomes were estimated using the Kaplan-Meier method, and intergroup differences were compared using the log-rank test. Risk factors for DM were identified through Cox regression analysis. A restricted cubic spline (RCS) curve was used to evaluate the association between the odds ratio (OR) for DM and cumulative platinum dose throughout treatment. Results: The most prevalent DM organ was the lung (51.1%), followed by liver (26.7%) and bone (24.4%). No significant difference regarding 5-year overall survival (OS) was observed between patients with single-site DM and those with multiple-site DM (44.2% Conclusions: The most common DM site for ADC patients after surgery and adjuvant radiotherapy was the lung. The risk factors for DM in those patients were LNM and DOI ≥1/2. Additionally, the prevention of DM could not be simply achieved by increasing the platinum dose during the primary treatment period.