2022-RA-1471-ESGO Radical hysterectomy is not superior to chemoradiation in early stage cervical cancer with suspicious lymph nodes: a propensity score analysis

Abstract

<h3>Introduction/Background</h3> This retrospective cohort study aims to compare radical hysterectomy with primary chemoradiation regarding survival and toxicity (≤6 months) in women with early-stage cervical cancer and suspicious lymph nodes on pretreatment imaging. <h3>Methodology</h3> Women diagnosed between 2009–2017 with International Federation of Gynaecology and Obstetrics (FIGO) 2009 stage IA-IIA, suspicious/inconclusive pelvic and/or para-aortic nodes on radiological judgement by pretreatment imaging (i.e. computed tomography, magnetic resonance imaging, and/or positron emission tomography), and treated by radical hysterectomy with lymphadenectomy, or chemoradiation were selected from the Netherlands Cancer Registry. Propensity score stratification for age, FIGO, tumour morphology and size, suspicious node short-axis, location, and status was applied to control for heterogeneity between both treatment groups. Overall and recurrence-free survival were compared by Cox regression analyses, toxicity (Clavien-Dindo grade ≥2 and Common Terminology Criteria for Adverse Events ≥3) by logistic regression. <h3>Results</h3> Of 319 patients included, 131 (41%) were treated by radical hysterectomy and 188 (59%) by chemoradiation. The pathological nodal status was known in 100% and 33% of the patients, of whom 43% (56/131) and 89% (54/61) had metastases, respectively. Radical hysterectomy was followed by (chemo)radiation in 54%. After balancing for confounding factors, radical hysterectomy yielded an almost similar overall (HR 0.91; CI 0.44–1.90) and recurrence-free (HR 1.18; CI 0.58–2.42) survival compared to chemoradiation (figure 1). However, radical hysterectomy was associated with more toxicity (n=44; 34%) compared to chemoradiation (n=37; 20%; p=0.006), also in adjusted analysis (OR 2.35; CI 1.18–4.68) and mainly caused by surgery-related complications (i.e. infection, bladder dysfunction, and blood transfusion) in 34 patients (26%). <h3>Conclusion</h3> After balancing confounding factors, overall and recurrence-free survival were not significantly different between radical hysterectomy and chemoradiation. Radical hysterectomy was associated with more toxicity compared to chemoradiation, mainly surgery-related and short-term.