Introduction: There is an ongoing debate regarding the optimal local treatment modalities for stage IB1 and IIA1 cervical cancer. The aim of this study was to determine whether radical hysterectomy or definitive radiochemotherapy is superior in stage IB1 and IIA1 cervical squamous cell carcinoma (SCC).
Methods: From 1990 to 2010, a total of 3,769 patients with stage IB1 and IIA1 cervical SCC were included from the Surveillance, Epidemiology, and End Results database and were stratified according to whether they received radical hysterectomy or primary radiochemotherapy. Propensity score-matching (PSM) methods were used to balance patient baseline characteristics. Cancer-specific survival (CSS) and overall survival (OS) were compared between the two groups.
Results: Of the 3,769 patients, 3,653 (96.9%) and 116 (3.1%) patients received radical hysterectomy and definitive radiochemotherapy, respectively. Radiochemotherapy was rarely used for definitive treatment prior to 2000. Before PSM, patients who were older, of black ethnicity, and with larger tumor size and stage IIA1 disease were more likely to receive definitive radiochemotherapy. A total of 116 pairs were completely matched using PSM. The local treatment modalities had no effect on CSS or OS in either unmatched or matched populations. In the matched population, the 8-year CSS rates were 82.1% and 76.5% in surgery and radiochemotherapy groups, respectively (p=0.382). The 8-year OS rates were 74.6% and 67.8% in surgery and radiochemotherapy groups, respectively (p=0.205).
Conclusion: Our population-based study suggests that there is no clear local treatment of choice on survival outcomes between radical hysterectomy and definitive radiochemotherapy in patients with stage IB1 and IIA1 cervical SCC.
Keywords: cervical cancer, early stage, hysterectomy, radiotherapy, propensity score matching
The incidence of cervical cancer (CC) has steadily declined over the last few decades coincident with the widespread, population-based screening. However, CC remains the third most common cancer in females and the fourth leading cause of cancer-related deaths in females worldwide, especially in low- and middle-income countries.1–3 For patients with locally advanced CC, definitive radiochemotherapy is the standard treatment,4 while neoadjuvant chemotherapy + radical surgery was also a choice of treatment.5–8 The standard treatment for stage IB1 and IIA1 CC is radical hysterectomy, whereas radiotherapy (RT) with or without chemotherapy is currently reserved as an optional treatment for nonoperative patients.9
Population-based studies have shown that most patients with stage IB–IIA CC underwent radical surgery rather than RT.10–12 One randomized study found that the survival outcomes between radical hysterectomy and primary RT were similar for stage IB–IIA cervical squamous cell carcinoma (SCC), whereas radical surgery was a better choice for patients with cervical adenocarcinoma.13 However, there is still ongoing debate regarding the optimal local treatment modalities for early-stage CC. Two previous population-based studies indicated that surgical treatment was associated with significantly better survival outcomes compared with primary RT in stage IB–IIA CC.10,11 A recent study of the National Cancer Database indicated that the addition of chemotherapy to definitive RT in stage IB1 and IIA1 CC improved overall survival (OS).14 The purpose of our study was to determine whether radical hysterectomy or definitive radiochemotherapy was superior in women with stage IB1 and IIA1 CC.