Comparison of oncological outcomes between radical hysterectomy and radiochemotherapy for FIGO 2018 stage IIIC1 cervical adenocarcinoma：a retrospective multicentre cohort study

Abstract

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,236 cases with 2018 FIGO stage IIIC1 cervical adenocarcinoma from 2005 to 2019 were reviewed. The 5-year OS and 5-year DFS of patients with either of the two treatment methods were compared by means of a multivariate Cox regression model and the log-rank method in the total study population and after propensity score matching (PSM). Results We selected 236 of 63,926 patients with 203 patients in the RH group and 33 patients in the R-CT group and then found that R-CT was associated with a 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) than RH in the total study population. R-CT is an independent risk factor for 5-year DFS(HR = 2.226, 95% CI 1.141–4.343, P < 0.05) in FIGO stage IIIC1 cervical adenocarcinoma, but not for 5-year OS(hazard ratio (HR) = 1.834 ,95% CI 0.829–4.061, P ༜ 0.05).After matching (n = 26/73), among FIGO 2018 IIIC1 adenocarcinoma patients the 5-year OS and DFS were lower in the R-CT group than in the RH group,the difference was statistically significant (OS: 50.3%vs77.4%,P ༜ 0.05;DFS: 38.2% vs. 65.0%, P < 0.05, respectively).R-CT is an independent risk factor for 5-year DFS(HR = 2.299, 95% CI 1.113–4.750, P < 0.05) in FIGO stage IIIC1 cervical adenocarcinoma, 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.