Comparison of survival outcomes following radiotherapy versus radical hysterectomy in patients with stage IIA cervical squamous cell carcinoma

Abstract

This study explored the differences in survival outcomes of cervical squamous cell carcinoma (SCC) patients diagnosed with stage IIA who underwent radical hysterectomy (RH) versus radiotherapy (RT). Eligible stage IIA cervical SCC cases were screened from the C4 database. They were divided into RH and RT groups based on their treatments and in a 1:2 ratio utilizing propensity score matching (PSM). Their 5-year overall survival (OS) and disease-free survival (DFS) before and after PSM were compared. Before PSM analysis, the results showed that patients from the RT group (n = 421) had significantly poorer 5-year OS and DFS rates compared with the RH group (n = 761) (OS: 77.2%vs. 85.6%, p < 0.001, HR = 1.789; DFS: 74.9% vs. 80.0%, p = 0.006, HR = 1.447). After stratification in a 1:2 ratio, PSM analysis results showed that the 5-year OS and DFS rates of stage IIA1 patients from the RT group (n = 226) were significantly poorer than the RH group (n = 429) (OS: 78.1% vs. 87.2%, p < 0.001, HR = 2.203; DFS: 78.2% vs. 83.7%, p = 0.011, HR = 1.681), while no significant difference in 5-year OS and DFS rates were observed between the RT (n = 173) and RH (n = 266) groups (OS: 75.2% vs. 83.8%, p = 0.054; DFS: 71.4% vs. 79.5%, p = 0.070) of stage IIA2 patients. RH was associated with better OS and DFS outcomes than RT in cervical SCC patients diagnosed with stage IIA disease. Subgroup analyses showed that RH had superior OS and DFS benefits than RT in stage IIA1 cases, while no significant difference in survival was observed for stage IIA2 patients.