Comparison of oncological outcomes between radical hysterectomy and radiochemotherapy for International Federation of Gynecology and Obstetrics 2018 stage IIIC1 cervical adenocarcinoma: A retrospective multicenter cohort study.

BACKGROUND

To compare oncological outcomes of radical hysterectomy (RH) and radiochemotherapy (R-CT) for stage IIIC1 (FIGO 2018) cervical adenocarcinoma patients.

METHODS

Based on the Chinese Cervical Cancer Clinical Diagnosis and Treatment Project Database, we retrospectively reviewed 236 cases of FIGO stage IIIC1 cervical adenocarcinoma diagnosed between 2005 and 2019. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) rates were compared between the two treatment groups using multivariate Cox regression models and the log-rank test, both in the overall study population and after propensity score matching (PSM).

RESULTS

From 63 926 patients, we selected 236 cases, including 203 in the RH group and 33 in the R-CT group. In the overall study population, R-CT was associated with significantly worse 5-year OS (51.8% vs. 67.2%, p < 0.05) and 5-year DFS (43.1% vs. 60.1%, p < 0.05) compared to RH. Multivariate analysis revealed that R-CT was an independent risk factor for 5-year DFS (hazard ratio [HR] = 2.226, 95% confidence interval [CI] 1.141-4.343, p < 0.05) but not for 5-year OS (HR = 1.834, 95% CI: 0.829-4.061, p > 0.05) in FIGO stage IIIC1 cervical adenocarcinoma. After matching (n = 26 in R-CT group vs. 73 in RH group), the R-CT group showed significantly lower 5-year OS (50.3% vs. 77.4%, p < 0.05) and DFS (38.2% vs. 65.0%, p < 0.05) compared to the RH group. In the matched cohort, R-CT remained an independent risk factor for 5-year DFS (HR = 2.299, 95% CI: 1.113-4.750, p < 0.05) but not for 5-year OS (HR = 1.926, 95% CI: 0.792-4.682, p > 0.05).

CONCLUSION

Among patients with stage FIGO 2018 IIIC1 cervical cancer adenocarcinoma, R-CT was not associated with better oncological outcomes than RH. Radiotherapy should not be the only recommended treatment.