Abstract
To estimate whether adjuvant radiotherapy is necessary for patients with stage IA1-IIA1 cervical cancer after laparoscopic hysterectomy, 221 patients were retrospectively analyzed. Sixty-two of them were treated with laparoscopic hysterectomy and adjuvant radiotherapy (group A), 115 underwent open surgery (group B) and 44 received laparoscopic hysterectomy alone (group C). Results showed that the 3-year local recurrence-free survival (LRFS) rates of group A, B and C were 98.4%, 97.4% and 86.4%, respectively. The LRFS rates of group A and B surpassed C (A vs. B, p=0.634; A vs. C, p=0.011; B vs. C, p=0.006). The inter-group differences of 3-year overall survival (OS) and distant metastasis free survival (DMFS) were not statistically significant. In subgroup analysis of stage IB disease, the 3-year LRFS rates of group A, B and C were 100%, 98.8% and 83.1%, the 3-year OS rates of group A, B and C were 100%, 98.9% and 91.5%, respectively. The 3-year LRFS and OS rates of group A and B were significantly superior to group C (p<0.05). Our findings suggest that adjuvant radiotherapy can reduce the risk of recurrence for women with early-stage cervical cancer after laparoscopic hysterectomy and bring survival benefits for patients with stage IB disease.
Highlights
According to National Comprehensive Cancer Network (NCCN) clinical guidelines, postoperative adjuvant radiotherapy is generally not required for stage IA1~IB cervical cancer patients if there are no high-risk factors or the intermediate risk factors do not meet the Sedlis criteria
All patients were restaged according to FIGO 2018 and whose previous diagnosis was stage IA-IIa cervical cancer but had positive lymph nodes were excluded from our analysis
Univariate analysis suggested that patients underwent laparoscopic hysterectomy alone had a higher rate of local recurrence than patients received laparoscopic hysterectomy combined with adjuvant radiotherapy or open surgery, Multivariate analysis found that a difference remained after the adjustment for, Eastern Cooperative Oncology Group (ECOG) performance-status score, stage of disease, age, and lymph-vascular invasion (LVSI)
Summary
According to National Comprehensive Cancer Network (NCCN) clinical guidelines, postoperative adjuvant radiotherapy is generally not required for stage IA1~IB cervical cancer patients if there are no high-risk factors (such as lymph-node involvement, nerve invasion, and large tumor) or the intermediate risk factors do not meet the Sedlis criteria. It can be speculated that minimally invasive surgery may bring the risk of local recurrence [2]. We speculate that minimally invasive hysterectomy for early cervical cancer carries a risk of local failure, it is worth studying whether additional postoperative radiotherapy is needed for these patients with minimally invasive surgery
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