FIGO IVB cervical cancer patients benefit from locoregional surgery: a retrospective study from the SEER database

Abstract Background: We aimed to analyze the clinical value of primary site surgery in improving survival of initial metastatic cervical cancer. Methods: A population-based retrospective study which analyzed clinical data extracted from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database was conducted. Stratified analysis was employed to evaluate the effect of cervical surgery on cervical cancer specific survival (CCSS) and overall survival (OS). Then COX regression models were performed to adjust potential confounders, and assess the survival benefit of cervical surgery for patients with primary metastatic cervical cancer. Results: The median CCSS and OS in the surgery group were more than twice of that in the group without surgery. Primary site surgery conferred prognosis superiority for patients with metastases merely to lung, and other site or distant LN, but not multiple metastasis and bone, liver. Pelvic lymph node dissection conducted in combination with cervical surgery provided a survival advantage over hysterectomy. Moreover, an aggressive treatment that integrated locoregional surgery with radiotherapy or chemotherapy showed the better survival when compared to surgery alone. The survival advantage provided by primary site surgery was not influenced by the histological type, lymph node status. Finally, after adjusting confounders using COX regression, local cervical surgery reduced the cancer related and overall mortality rate by about 30%. Conclusions: Surgical procedures could promote the survival of patients with primary metastatic cervical cancer, and should be considered as a therapeutic option for carefully chosen patients.