ObjectiveThis study aimed to explore the best treatment strategy for International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIA1 cervical cancer patients by comparing the survival outcomes of two treatment methods: abdominal radical hysterectomy (ARH) with standard postoperative therapy and radio-chemotherapy (R-CT).MethodsPatients with FIGO2018 stage IIA1 cervical cancer who underwent ARH or received R-CT were screened from the clinical diagnosis and treatment for cervical cancer in China (Four C) database. The recurrence cases between the two groups were analyzed. The 5-year overall survival (OS) and disease-free survival (DFS) of patients diagnosed with stage IIA1 cervical cancer in 47 hospitals in mainland China between 2004 and 2018 were compared by using propensity score matching (PSM).ResultsA total of 724 patients met the inclusion criteria. In the total study population, The R-CT group had higher recurrence (22.8% for the R-CT group and 11.2% for the ARH group, P<0.001) rates compared to the ARH group.The 5-year OS and DFS of the ARH group (n=658) were significantly higher than those of the R-CT group (n=66) (OS: 85.9% vs. 71.2%, P=0.009; DFS: 79.2%vs. 70.5%, P=0.027). R-CT was associated with worse 5-year OS (HR=3.19, 95% CI: 1.592-6.956, P=0.001) and DFS (HR=2.089, 95% CI: 1.194-3.656, P=0.01). After 1:2 PSM, the 5-year OS and DFS of the ARH group (n=126) were significantly higher than those of the R-CT group (n=64) (OS:88.9% vs. 70.1%, P=0.04; DFS:82.8% vs. 69.8%, P=0.019). R-CT was still associated with worse 5-year OS (HR=2.391, 95% CI: 1.051-5.633, P=0.046) and DFS (HR=2.6, 95% CI: 1.25-5.409, P=0.011).ConclusionOur study demonstrated that for stage FIGO2018 stage IIA1 cervical cancer patients, ARH offers better oncological outcomes than R-CT.

Background: Nomograms are predictive tools widely used for estimating cancer prognosis. We aimed to develop/validate a nomogram to predict the postsurgical 5-year overall survival (OS) and disease-free survival (DFS) probability for patients with stages IB1, IB2, and IIA1 cervical cancer [2018 International Federation of Gynecology and Obstetrics (FIGO 2018)]. Methods: We retrospectively enrolled cervical cancer patients at 47 hospitals with stages IB1, IB2, and IIA1 disease from the Clinical Diagnosis and Treatment for Cervical Cancer in China database. All patients were assigned to either the development or validation cohort (75% of patients used for model construction and 25% used for validation). OS and DFS were defined as the clinical endpoints. Clinicopathological variables were analyzed based on the Cox proportional hazards regression model. A nomogram was established and validated internally (with bootstrapping) and externally, and its performance was assessed according to the concordance index (C-index), receiver-operating characteristic curve, and calibration plot. Results: In total, 4,065 patients were enrolled and assigned to the development cohort (n=3,074) or validation cohort (n=991). The OS nomogram was constructed based on age, FIGO stage, stromal invasion, and lymphovascular space invasion (LVSI). The DFS nomogram was constructed based on the FIGO stage, histological type, stromal invasion, and LVSI. Both nomograms showed greater discrimination than the FIGO 2018 staging system in the development cohort [OS nomogram vs. FIGO 2018: C-index =0.69 vs. 0.61, area under the curve (AUC): 69.8 vs. 60.3; DFS nomogram vs. FIGO 2018: C-index =0.64 vs. 0.57, AUC: 62.6 vs. 56.9], and the same results were observed the definition in the validation cohort. Calibration plots demonstrated good agreement between the predicted and actual probabilities of 5-year OS/DFS in the development and validation cohorts. We stratified the patients into 3 subgroups with differences in OS/DFS.Each risk subgroup presented a distinct prognosis.^ ORCID: 0000-0002-1708-3047. Conclusions:We successfully developed a robust and powerful model for predicting 5-year OS/DFS in stages IB1, IB2, and IIA1 cervical cancer (FIGO 2018) for the first time. Internal and external validation showed that the model had great prediction performance and was superior to the currently utilized FIGO staging system.

Objective To compare long‐term outcomes between pre‐operative radiotherapy followed by open surgery and direct open surgery among women with Stage IB1–IIB cervical squamous cell carcinoma. Methods A multicenter retrospective cohort study among women with Stage IB1–IIB cervical squamous cell carcinoma who underwent open surgery either directly (SD group) or with pre‐operative radiotherapy (PR group) in China 2004–2016. Five‐year overall survival (OS) and disease‐free survival (DFS) between the two groups were compared by Kaplan–Meier methods and multivariate Cox regression. Results Overall, 8385 women with Stage IB1–IIB were included (PR group, n = 447; SD group, n = 7938). Five‐year OS and DFS was significantly lower in the PR than in the SD group (OS: 81.7% vs 91.6%, P < 0.001; DFS: 76.3% vs 86.7%, P < 0.001). As compared with direct surgery, pre‐operative radiotherapy was an independent risk factor for 5‐year OS (adjusted hazard raio [aHR], 1.75; 95% confidence interval [CI], 1.34–2.30) and DFS (aHR, 1.37; 95% CI, 1.09–1.73) by multivariate Cox regression. Sensitivity analyses confirmed the findings. Conclusion Among women with Stage IB1–IIB cervical squamous cell carcinoma, outcomes were found to be worse for those undergoing pre‐operative radiotherapy followed by open surgery than for those undergoing direct open surgery.

Objective This study aimed to explore the optimal treatment strategy for International Federation of Gynecology and Obstetrics 2018 stage ⅡB cervical adenocarcinoma patients. Methods cervical adenocarcinoma patients who underwent radical hysterectomy and radical radio-chemotherapy were screened from the clinical diagnosis and treatment for cervical cancer in China database. The 5-year overall survival (OS) and disease-free survival (DFS) were compared using the overall population study and propensity score matching. Results 68 FIGO2018 stage Ⅱ B cervical adenocarcinoma patients were eligible for inclusion. In the overall population study, there was no statistical difference in 5-year OS between the surgery group (n = 41) and the radical radio-chemotherapy group (n = 27), but their DFS was better than that of the radical radio-chemotherapy group (OS: 85.7%vs.62.8%, P = 0.058; DFS: 83.7%vs.59.2%, P = 0.035), the difference was statistically significant. Cox multivariate analysis showed that patients with FIGO2018 stage Ⅱ B cervical adenocarcinoma had worse 5-year OS (HR = 2.036, 95%CI: 0.451–9.21, P = 0.355) and DFS (HR = 1.296, 95%CI: 0.344–5.030, P = 0.708). After 1:1PSM, there were no significant differences in OS and DFS between the surgery group (n = 16) and the radical radio-chemotherapy group (n = 16)(OS: 79.8%vs.92.3%, P = 0.292; DFS: 85.6%vs.68.8%, P = 0.228). Cox multivariate analysis showed that treatment was not an independent risk factor for worse 5-year OS (HR = 0.346, 95%CI: 0.035–3.441, P = 0.365) or DFS (HR = 0.399, 95%CI: 0.075–2.216, P = 0.282). In terms of recurrence after treatment in patients with FIGO2018 stage Ⅱ B cervical adenocarcinoma, the results were consistent before and after matching, and there was no statistical difference between the two groups in terms of recurrence, recurrence time, recurrence site after recurrence. Conclusion For patients with FIGO 2018 stage Ⅱ B cervical adenocarcinoma, radical chemoradiotherapy did not result in better oncology outcome.