We primarily aimed to investigate the therapeutic role of conization prior to radical hysterectomy for cervical cancer. Secondarily, we aimed to characterize a subgroup of patients who could potentially benefit from preoperative conization. Patients who underwent radical hysterectomy for FIGO 2009 stage IB1 to IIB cervical cancer from 1995 to 2020 were eligible. The patients were divided into two groups: those with and without preoperative conization. To adjust for the baseline characteristics of the two groups, 1:2 case–control propensity score matching was conducted. Survival analysis was performed between the two groups. Subgroup analysis was performed to identify the effect of conization based on clinical and pathological factors. Patients who underwent preoperative conization showed better 5-year overall survival than those who did not (95.9% vs. 93.0%, p = 0.029); however, no difference was observed in progression-free survival (88.9% vs. 85.9%, p = 0.155). In multivariate Cox analysis, conization showed a 55% reduction in recurrence (hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.41–1.01, p = 0.056) and 41% reduction in death (HR 0.59, 95% CI 0.34–1.02, p = 0.059), but with marginal statistical significance. In subgroup analysis, minimally invasive surgery (MIS), negative pelvic lymph node, and tumor size < 4 cm showed improved survival from conization. Conization before radical hysterectomy may be associated with improved survival in patients with early-stage cervical cancer. This information could serve as a basis for a more tailored patient selection for MIS for cervical cancer.

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Contentsinto two groups-adjuvant pelvic radiation (116 patients) and no adjuvant treatment (114 patients). The propensity scores were employed to balance the 2 study groups with respect to distribution of confounding factors. The primary outcomes were disease-free survival (DFS) and overall survival (OS). The secondary outcomes included treatment complications and quality of life. Results: The DFS were comparable between the groups with the adjusted hazard ratio (aHR) 0.46 (95% confidence interval [CI]=0.18-1.16; p=0.1) for adjuvant radiation. Similarly, the OS were not significantly different with the aHR 1.75 (95% CI=0.63-4.90; p=0.3) for adjuvant radiation. Serious side effects were reported in 4 patients, 3 in the adjuvant radiation group (2 lymphedema and 1 enterovesical fistula) and 1 in the no adjuvant treatment group (lymphedema). Quality of life scores were not significantly different. Conclusion:The survival benefit of adjuvant pelvic radiation for intermediate-risk early-stage cervical cancer could not be demonstrated in this study.