Comparative Effectiveness of Radical Surgery versus Concurrent Chemoradiotherapy in Stage IB3, IIA2, or IIICr Cervical Cancer: A Prospective, Multicenter, Propensity Score-Matched Cohort Study

Comparative Effectiveness of Radical Surgery versus Concurrent Chemoradiotherapy in Stage IB3, IIA2, or IIICr Cervical Cancer: A Prospective, Multicenter, Propensity Score-Matched Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative Effectiveness of Radical Surgery versus Concurrent Chemoradiotherapy in Stage IB3, IIA2, or IIICr Cervical Cancer: A Prospective, Multicenter, Propensity Score-Matched Cohort Study Qinqin Liu, Wenwen Liu, Yan Huang, Yunhai Li, Liwen Jiang, Shugen Sun, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9161019/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Background While concurrent chemoradiotherapy (CCRT) is the standard first-line treatment, radical surgery (RS) is frequently preferred in China, despite unclear comparative efficacy. The role of minimally invasive surgery also remains controversial and requires further validation. These persistent uncertainties underscore the need to advance research into LACC treatment strategies. Methods We conducted a multicenter prospective cohort study at three tertiary teaching hospitals in Shanghai, including 246 patients with specific locally advanced cervical cancer (LACC; FIGO 2018 stages IB3, IIA2, or IIICr). We compared overall survival (OS), progression-free survival (PFS), adverse events (AEs), and two-year quality-adjusted life years (QALYs) between RS (n = 198) and definitive CCRT (n = 48), and further compared tumor-free laparoscopic RS (n = 119) with open RS (n = 79). Propensity score matching (PSM) was applied to reduce potential confounding. Subgroup analyses were conducted according to key clinical factors, and sensitivity analyses were performed to assess the robustness of the results. Results After PSM, there were no significant differences in OS or PFS between the RS and the definitive CCRT groups (Two-year OS: 92% [86–97%] vs. 91% [82–100%]; Two-year PFS: 79% [72–87%] vs. 78% [66–91%]), nor between the tumor-free laparoscopic and the open RS groups (Two-year OS: 97% [93–100%] vs. 91% [84–98%]; Two-year PFS: 82% [74–92%] vs. 78% [69–89%]). Subgroup and sensitivity analyses yielded consistent findings. Two-year QALYs were comparable between the RS and the definitive CCRT groups (23.55 [22.54, 24.00] vs. 23.53 [22.60, 23.80] months; w = 3148, p = 0.074), but significantly higher in the tumor-free laparoscopic RS group than in the open RS group (24.00 [23.52, 24.00] vs. 23.52 [21.77, 24.00] months; w = 3060, p = 0.003). Conclusions RS and definitive CCRT provided comparable survival outcomes and two-year QALYs in specific LACC patients (FIGO 2018 stages IB3, IIA2, or IIICr). Within the surgical cohort, tumor-free laparoscopic RS achieved similar survival outcomes as open RS but offered better two-year QoL benefits, supporting its role as a potential surgical option under strict oncologic principles. Locally advanced cervical cancer (LACC) Radical surgery Laparoscopy Hysterectomy Prognosis PSM Figures Figure 1 Figure 2 Figure 3 Figure 4 HIGHLIGHTS Comparable Efficacy of Radical Surgery RS achieved equivalent OS, PFS, and 2-year QALYs compared to definitive CCRT in specific LACC patients. Non-Inferiority of Laparoscopic Approach When adhering to tumor-free principles, laparoscopic RS provided equivalent oncologic outcomes to open surgery, while also being associated with superior 2-year QALYs. Evidence for Personalized Treatment This prospective cohort study provides high-level evidence to guide personalized clinical decision-making, supporting both RS as an alternative to CCRT and a laparoscopic approach for specific LACC patients. INTRODUCTION Cervical cancer (CC) is a major global health concern and the fourth leading cause of cancer-related death in women worldwide [ 1 ]. In China, inadequate cervical screening leads to 40–60% of patients being diagnosed with locally advanced cervical cancer (LACC; FIGO 2018 stages IB3–IVA) at initial presentation [ 2 ]. The optimal treatment for specific LACC stages (FIGO 2018 stages IB3, IIA2, or IIICr) remains controversial. Although the NCCN 2025 guidelines recommend concurrent chemoradiotherapy (CCRT) as a Category 1 preferred treatment, radical surgery (RS), which is categorized as a 2B option, remains widely used in clinical practice in China. This preference reflects uneven radiotherapy resources, limitations in imaging-based staging accuracy, and strong patient inclination toward surgical resection [ 3 ]. RS provides distinct advantages, including effective cytoreduction and accurate histopathological staging to guide adjuvant therapy. Retrospective analyses have demonstrated superior survival outcomes in surgical cohorts compared to non-operative management [ 4 – 7 ]. Nevertheless, the substantial tumor burden of LACC poses technical challenges during surgery. Moreover, the frequent occurrence of high- or intermediate-risk pathological features often necessitates adjuvant therapy. This therapeutic overlap may increase treatment-related morbidity and adversely affect quality of life (QoL) [ 8 ]. Therefore, prospective investigations with large-scale cohorts from multiple centers are needed to provide higher-level evidence for the standardization of surgical strategies in LACC. Recent studies have raised serious concerns about the oncologic safety of laparoscopic surgery for CC, highlighting a significant increase in recurrence rates and prompting a re-evaluation of its role in treatment. The landmark phase III multicenter Laparoscopic Approach to Cervical Cancer trial demonstrated that minimally invasive surgery was linked to lower disease-free survival (DFS) compared to open surgery in women with early-stage CC [ 9 , 10 ]. However, the RCT’s requirement of only 10 laparoscopic procedures per surgeon may be insufficient to achieve the necessary proficiency for type C RH according to the Querleu-Morrow classification. Moreover, advancements in laparoscopic techniques and growing surgical experience have enhanced its effectiveness over time [ 11 , 12 ]. Thus, the conclusions of the Laparoscopic Approach to LACC may not be applicable. To date, only a few studies have compared surgical and oncologic outcomes between laparoscopic and abdominal RS in LACC patients [ 13 – 18 ]. These studies have shown that there is no significant difference in prognosis between laparoscopic and open surgery when using the Non-touch Isolation Technique. However, the small sample size and retrospective design of these studies limit their conclusions’ further application. To bridge these evidence gaps, we conducted a prospective multicenter cohort study comparing prognosis and QoL in specific LACC patients (FIGO 2018 stages IB3, IIA2, or IIICr) undergoing one of three treatments: (i) open RS (Arm A1), (ii) tumor-free laparoscopic RS (Arm A2), or (iii) definitive CCRT (Group B). Propensity score matching (PSM) was applied to minimize confounding between treatment groups, and the study aims to provide high-level prospective evidence to help expand therapeutic options for this patient population. This cohort study has been reported in line with the STROCSS guidelines [ 19 ]. METHODS Study design and patients This multicenter cohort study aimed to compare the overall survival (OS), progression-free survival (PFS), adverse events (AEs), and two-year QALYs between the RS and the definitive CCRT in specific LACC patients (FIGO 2018 stages IB3, IIA2, or IIICr), evaluating differences between tumor-free laparoscopic and open radical approaches within the RS group. We analyzed patients diagnosed with specific LACC between April 2020 and December 2022 at three tertiary teaching hospitals in Shanghai, China. Inclusion criteria: (1) Aged 18–70 years; (2) Clinically diagnosed with specific LACC (FIGO 2018 stages IB3, IIA2, or IIICr); (3) Underwent RS or received definitive CCRT. Exclusion criteria: (1) History of prior chemotherapy or radiotherapy; (2) Pregnancy or a history of other malignancies; (3) Evidence of distant metastasis on imaging. Treatments and Follow-up The surgical protocol for Group A (RS cohort) consisted of two standardized approaches: open RS (Arm A1) and tumor-free laparoscopic RS (Arm A2). Both arms involved the same surgical procedures: radical hysterectomy (RH), bilateral salpingectomy (BS), with or without oophorectomy, pelvic lymphadenectomy (PLD), with or without para-aortic lymphadenectomy (PALD). To ensure strict adherence to tumor-free principles during RS, several key measures have been implemented: Peritoneal Irrigation Cisplatin and hypotonic sterile water were used during RH to minimize the risk of tumor dissemination. Secure Ligation The vagina beneath the cervical lesion was ligated before uterus removal, with cisplatin irrigation applied both before and after ligation, ensuring the hysterectomy specimen remained intact. All the surgeries will be performed by qualified and experienced surgeons with certificates to perform RH, PLD, and PALD. Moreover, participating surgeons have an annual volume of more than 50 cases of RH, PLD, and PALD. Participants who receive definitive CCRT (group B) will receive treatment following NCCN radiation therapy guidelines. Follow-up assessments were conducted through telephone interviews and outpatient visits. The last follow-up was conducted in September 2024. We will conduct standardized postoperative follow-ups strictly following the NCCN guidelines every three months for two years, every six months for another three years, and then annually. All follow-up investigators underwent rigorous training to ensure data accuracy and consistency. Additional treatment details and follow-up procedures are provided in Table S1 -4 . Data collection and survival outcomes Patients’ information, including age, histological type, maximum tumor diameter, FIGO stage, tumor invasion and metastasis status, and specific treatment modalities, was collected at the time of cohort enrollment. The primary outcomes of interest included PFS and OS, with secondary endpoints including treatment-related AEs and two-year QALY assessments. OS was defined as the interval from the date of enrollment to death from any cause. PFS was defined as the time from enrollment to the first documentation of disease progression or death from any cause. Distant metastasis-free survival (DMFS) was calculated from the date of treatment initiation (either radical surgery or the first session of CCRT) to the first evidence of distant metastasis or death from any cause, whichever occurred first. Distant metastasis was defined as any tumor recurrence outside the pelvis or beyond the regional lymph nodes, as confirmed by clinical assessment and imaging modalities (e.g., CT, MRI, or PET-CT) according to the RECIST 1.1 criteria. For all endpoints, patients who were alive and event-free at the time of the last follow-up were censored at the date of their last contact. To evaluate patients’ QoL, we estimated QALYs over a two-year horizon by assigning utility values to specific health states. Health states included treatment-related AEs (leukopenia/neutrophil reduction, thrombocytopenia, anemia, diarrhea, nausea/vomiting, intestinal fistula, chronic gastrointestinal complications, and chronic genitourinary complications) as well as recurrence/progression. The corresponding utility values, ranging from 0.50 to 0.98, were derived from previously published literature ( Table 1 ). QALYs were calculated as the sum of time spent in each health state multiplied by its respective utility value: Table 1 Utility values assigned to health states for QALY calculation Health state Utility value Source Leukopenia/Neutrophil reduction 0.80 Literature[ 27 ] Thrombocytopenia 0.73 Literature[ 28 ] Anemia 0.62 Literature[ 28 ] Diarrhea 0.89 Literature[ 29 ] Nausea/Vomiting 0.98 Literature [ 28 ] Intestinal fistula 0.50 Literature[ 30 ] Chronic gastrointestinal complications a 0.63 Literature [ 30 ] Chronic genitourinary complications b 0.55 Literature [ 30 ] Recurrence/Progression 0.52 Literature [ 28 ] QALY = \(\:\sum\:_{i\:=\:1}^{n}(\:{Utility}_{i}\times\:{Time}_{i}\:\) ) a Including intestinal obstruction and rectovaginal fistula b Including hydronephrosis, bladder dysfunction, and vesicovaginal fistula Statistical Analysis Propensity scores for each patient were generated using logistic regression analysis, incorporating the covariates of age, histological type, maximum tumor diameter, FIGO stage, and lymph node metastasis. PSM was applied at a 1:3 ratio to compare patients who received definitive CCRT with those who underwent RS primarily, using a caliper width of 0.2 times the standard deviation of the logit of the propensity score [ 20 ]. To analyze the prognosis of patients undergoing tumor-free laparoscopic RS and open RS, PSM was applied at a 1:1 ratio. After matching, the primary comparisons focused on OS, PFS (including DMFS), AEs, and two-year QALYs between the following groups: (i) RS and definitive CCRT, and (ii) tumor-free laparoscopic RS and open RS. In addition, matched pair analyses were performed to further evaluate prognostic outcomes between (a) RS patients with consistent preoperative and postoperative FIGO staging and matched CCRT patients, (b) open RS and matched CCRT patients, and (c) laparoscopic RS and matched CCRT patients. Baseline characteristics were compared between the treatment groups using the t-test, chi-square test, and Fisher’s exact test, as appropriate. Survival outcomes were estimated using the Kaplan-Meier method and compared with the log-rank test. The Wilcoxon rank-sum test was used to compare two-year QALYs both across treatment strategies and across surgical approaches within the RS group. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and conduct subgroup analyses stratified by age, maximum tumor diameter, FIGO stage, and surgeon’s department in the PSM cohort. Interaction effects between subgroup variables and treatment strategies (or surgical approaches) were assessed by including interaction terms in the Cox models, and corresponding p values for interaction were calculated. To account for multiple subgroup comparisons, the false discovery rate (FDR) method was applied, and adjusted q values were reported. Sensitivity analyses were performed by repeating PSM at a 1:2 ratio for RS therapy versus definitive CCRT. All statistical analyses were conducted using R version 4.3.1. RESULTS Participant characteristics As shown in Fig. 1 , 246 patients were included in this study, among whom 198 patients were in the RS and 48 patients were in the definitive CCRT group. Of the RS group, 119 received tumor-free laparoscopic surgery and 79 underwent open surgery. Baseline patient characteristics before PSM are summarized in Table S5 . PSM was performed based on pretreatment characteristics, including age, histological type, radiologically suggested maximum tumor diameter, FIGO stage, and lymph node metastasis status, to balance patients receiving different treatment strategies (RS vs. definitive CCRT) and surgical approaches (tumor-free laparoscopic RS vs. open RS). These resulted in matched cohorts of 114 RS patients versus 47 CCRT patients for comparative effectiveness analysis, and 69 patients per group for surgical outcomes comparison. Post-PSM assessment confirmed well-balanced baseline characteristics between both paired cohorts, as detailed in Table 2 . All variables showed no statistically significant differences. Table 2 Baseline characteristics after propensity score matching Variables Treatment strategy Surgical approach Radical surgery (RS) group (n = 114) Definitive CCRT † group (n = 47) t/ χ 2 /Z p value Tumer-free laparoscopic RS group (n = 69) Open RS group (n = 69) t/ χ 2 /Z p value Age (median [IQR]) 55 [48, 60] 53 [49, 61] 2719.500 a 0.882 52 [44, 58] 52 [46, 59] 2417.000 a 0.878 Histological type 0.999 0.999 Squamous cell carcinoma 96.49% (110/114) 95.74% (45/47) 89.86% (62/69) 88.41% (61/69) Adenosquamous carcinoma/ Adenocarcinoma 3.51% (4/114) 4.26% (2/47) 10.14% (7/69) 11.59% (8/69) Maximum tumor diameter, cm 6.30 [5.10, 6.80] 5.80 [4.45, 6.90] 3103.500 a 0.214 6.60 [5.60, 7.30] 6.70 [5.77, 7.47] 2265.000 a 0.624 FIGO stage 0.089 c 0.929 0.129 b 0.988 I B3 8.77% (10/114) 6.38% (3/47) 15.94% (11/69) 17.39% (12/69) II A2 21.93% (25/114) 19.15% (9/47) 26.09% (18/69) 27.54% (19/69) III C1R 59.65% (68/114) 65.96% (31/47) 50.72% (35/69) 47.83% (33/69) III C2R 9.65% (11/114) 8.51% (4/47) 7.25% (5/69) 7.25% (5/69) FIGO stage III 0.527 b 0.468 0.552 b 0.458 Maximum tumor diameter ≤ 4 cm 15.19% (12/79) 22.86% (8/35) 10.00% (4/40) 18.42% (7/38) Maximum tumor diameter > 4 cm 84.81% (67/79) 77.14% (27/35) 90.00% (36/40) 81.58% (31/38) Medically managed comorbidities Hypertension 17.54% (20/114) 17.02% (8/47) 0.999 15.94% (11/69) 8.70% (6/69) 1.073 b 0.300 Diabetes 8.77% (10/114) 14.89% (7/47) 1.110 c 0.267 4.35% (3/69) 7.25% (5/69) 0.361 c 0.718 Anemia 13.16% (15/114) 14.89% (7/47) 0.002 b 0.969 14.49% (10/69) 18.84% (13/69) 0.209 b 0.648 Imaging-detected lymph node metastasis 69.30% (79/114) 74.47% (35/47) 0.217 b 0.642 57.97% (40/69) 55.07% (38/69) 0.029 b 0.864 Pelvic lymph nodes 12.28% (14/114) 21.28% (10/47) 1.473 b 0.225 13.04% (9/69) 8.70% (6/69) 0.299 b 0.584 Parametrial nodes 5.26% (6/114) 8.51% (4/47) 0.706 c 0.480 4.35% (3/69) 1.45% (1/69) 0.496 c 0.620 Iliac lymph nodes 55.26% (63/114) 55.32% (26/47) 0.999 46.38% (32/69) 43.48% (30/69) 0.029 b 0.864 Retroperitoneal nodes 4.39% (5/114) 14.89% (7/47) 2.044 c 0.041 * 2.90% (2/69) 5.80% (4/69) 0.411 c 0.681 Paraaortic nodes 8.77% (10/114) 8.51% (4/47) 0.999 7.25% (5/69) 7.25% (5/69) 0.999 CCRT treatment strategy CCRT + brachytherapy — 97.87% (46/47) — — CCRT — 2.13% (1/47) — — Adjuvant therapy ‡ 0.085 c 0.932 Chemoradiotherapy + brachytherapy 19.30% (22/114) — 18.84% (13/69) 15.94% (11/69) Chemoradiotherapy 76.31% (87/114) — 78.26% (54/69) 81.16% (56/69) No required 4.39% (5/114) — 2.90% (2/69) 2.90% (2/69) Department of surgery ‡ 0.383 b 0.536 Gynecologic oncology 82.46% (94/114) — 75.36% (52/69) 81.16% (56/69) General gynecology 17.54% (20/114) — 24.64% (17/69) 18.84% (13/69) Surgical procedure ‡ Open surgery 37.72% (43/114) — — — Tumer-free laparoscopic surgery 62.28% (71/114) — — — Positive surgical margins ‡ 18.42% (21/114) — 18.84% (13/69) 15.94% (11/69) 0.050 b 0.822 Parametrial invasion ‡ 0.947 b 0.623 None 71.93% (82/114) — 68.11% (47/69) 66.67% (46/69) Unilateral infiltration 24.56% (28/114) — 26.09% (18/69) 23.19% (16/69) Bilateral infiltration 3.51% (4/114) — 5.80% (4/69) 10.14% (7/69) Pathological lymph node metastasis ‡ 55.26% (63/114) — 50.72% (35/69) 50.72% (35/69) 0.999 Pelvic lymph nodes 24.56% (28/114) — 14.49% (10/69) 33.33 (23/69) 5.735 b 0.017 Parametrial nodes 10.53% (12/114) — 7.25% (5/69) 10.14% (7/69) 0.091 b 0.763 Iliac lymph nodes 44.74% (51/114) — 50.73% (35/69) 26.09% (18/69) 7.842 b 0.005 * Obturator lymph nodes (OLNs) 2.63% (3/114) — — 7.25% (5/69) Paraaortic nodes 14.91% (17/114) — 14.49% (1069) 14.49% (1069) 0.999 Lymphovascular space invasion (LVSI) ‡ 79.82% (91/114) — 73.91% (51/69) 88.41% (61/69) 3.839 b 0.050 Maximum tumor diameter, cm ‡ 4.65 [4.00, 5.40] — 5.00 [4.00, 6.00] 4.50 [4.00, 5.50] 2603.500 a 0.340 Cervical stromal invasion ‡ 0.393 c 0.694 Superficial invasion 2.63% (3/114) — 2.90% (2/69) 1.45% (1/69) Intermediate invasion 7.80% (9/114) — 5.80% (4/69) 4.35% (3/69) Deep invasion 34.21% (39/114) — 39.13% (27/69) 31.88% (22/69) Full-thickness invasion 55.26% (63/114) — 52.17% (36/69) 62.32% (43/69) Perineural invasion ‡ 11.40% (13/114) — 13.04% (9/69) 20.29% (14/69) 0.835 b 0.361 Vaginal invasion ‡ 1.402 c 0.161 None 37.72% (43/114) — 49.27% (34/69) 36.23% (25/69) Upper third 57.89% (66/114) — 44.93% (31/69) 60.87% (42/69) Middle third 4.39% (5/114) — 5.80% (4/69) 2.90% (2/69) a Wilcoxon rank-sum test b Chi-square test c Fisher's exact Test * p < 0.05 † Concurrent chemoradiotherapy ‡ Surgical approaches and postoperative parameters in the radical hysterectomy group After matching, additional clinicopathological and treatment-related factors were compared between the tumor-free laparoscopic RS and open RS groups, including department of surgery, positive surgical margins, parametrial invasion, lymph node metastasis, LVSI status, maximum tumor diameter, cervical stromal invasion, perineural and vaginal invasion. No significant differences were observed. To further rigorously assess the balance of covariates after PSM, standardized mean differences (SMDs) were calculated. As shown in Table S6 , all SMDs for the matched variables were below 0.2, indicating that an excellent baseline balance was achieved between the groups. Importantly, based on postoperative pathology, among the patients in the RS group, 19.30% received adjuvant chemoradiotherapy combined with brachytherapy, while the majority (76.31%) received chemoradiotherapy alone. A small proportion (4.39%, 5/114) did not require adjuvant therapy. The baseline characteristics are summarized in Table 2 . Prognosis in different treatment strategies and surgical approaches following propensity score matching After a median follow-up of 38 months (interquartile range, 24–45) in the comparison of treatment strategies (RS vs. CCRT), the RS group experienced 9 death events (9/114) and 23 recurrence events (23/114). In comparison, the definitive CCRT group recorded 4 deaths (4/47) and 10 recurrence events (10/47). The two-year OS rates were 92% (86–97%) for the RS group and 91% (82–100%) for the definitive CCRT group, with two-year PFS rates of 79% (72–87%) and 78% (66–91%), respectively ( Table 3 – 4 ) . No significant differences were observed in OS or PFS (including distant metastasis-free survival, DMFS) between the two strategies ( Fig. 2 , Figure S1 ) . Additionally, among patients in the RS group with consistent FIGO staging before and after surgery, comparison with the CCRT group also showed no statistically significant differences in OS or PFS ( Figure S2 ). Table 3 Recurrence and adverse effects after propensity score matching Variables Treatment strategy Surgical approach Radical surgery (RS) group (n = 114) Definitive CCRT † group (n = 47) t/ χ 2 /Z p value Tumer-free laparoscopic RS group (n = 69) Open RS group (n = 69) t/ χ 2 /Z p value Recurrence Central recurrence 3.51% (4/114) — 2.90% (2/69) 5.80% (4/69) 0.785 d 0.435 Non-central recurrence 0.88% (1/114) — 2.90% (2/69) —— Extraperitoneal lymph node metastasis 2.63% (3/114) 4.26% (2/47) 0.294 c 0.588 —— 5.80% (4/69) Distant recurrence 16.67% (19/114) 19.15% (9/47) 0.243 c 0.628 17.39% (12/69) 15.94% (11/69) 0.043 c 0.835 Unknown — 2.13% (1/47) —— —— Adverse events Leukopenia/Neutrophil reduction 10.53% (12/114) 38.30% (18/47) 15.147 c < 0.001 * 1.45% (1/69) 21.74% (15/69) 11.948 c 0.001 * Thrombocytopenia 2.63% (3/114) 31.91% (15/47) 25.865 c < 0.001 * 1.45% (1/69) 2.90% (2/69) 0.999 Anemia 1.75% (2/114) 27.66% (13/47) 3.291 d < 0.001 * 1.45% (1/69) 1.45% (1/69) 0.999 Diarrhea 6.14% (7/114) 8.51% (4/47) 0.342 d 0.732 2.90% (2/69) 4.35% (3/69) 0.999 Nausea/Vomiting 0.88% (1/114) 6.38% (3/47) 1.780 d 0.075 — — — — Intestinal fistula — 2.13% (1/47) — — — 1.45% (1/69) — — Chronic gastrointestinal complications a — — — Intestinal obstruction 2.63% (3/114) — — — 5.80% (4/69) — — — Rectovaginal fistula — 2.13% (1/47) — — — — — — Chronic genitourinary complications b Hydronephrosis 0.88% (1/114) — — — — 1.45% (1/69) — — Bladder dysfunction 10.53% (12/114) — — — 17.39% (12/69) 8.70% (6/69) 1.686 c 0.194 Vesicovaginal fistula 13.16% (15/114) — — — 15.94% (11/69) 10.14% (7/69) 0.669 c 0.413 a Including intestinal obstruction and rectovaginal fistula b Including hydronephrosis, bladder dysfunction, and vesicovaginal fistula c Chi-square test d Fisher's exact Test * p < 0.05 † Concurrent chemoradiotherapy ‡ Surgical approaches and postoperative parameters in the radical hysterectomy group Table 4 Survival Rates by Treatment Groups and surgery groups after propensity score matching Group Overall survival Progression-free survival two-year, % (95% CI) Events/patients, No. (%) two-year, % (95% CI) Events/patients, No. (%) Treatment strategy Radical surgery (RS) group 92 (86–97) 9/114 (8) 79 (72–87) 23/114 (20) Definitive CCRT † group 91 (82–100) 4/47 (99) 78 (66–91) 10/47 (213) Surgical approach Tumer-free laparoscopic RS group 97 (93–100) 2/69 (2) 82 (74–92) 12/69 (17) Open RS group 91 (84–98) 6/69 (9) 78 (69–89) 14/69 (20) † Concurrent chemoradiotherapy After a median follow-up of 37 months (interquartile range, 23–43 months) in the comparison between tumor-free laparoscopic and open RS groups, the tumor-free laparoscopic RS group recorded 6 deaths (6/69) and 16 disease recurrences (16/69), while the open RS group had 6 deaths (6/69) and 19 recurrences (19/69). The two-year OS rates were 97% (93–100%) for the tumor-free laparoscopic RS group and 91% (84–98%) for the open RS group. The two-year PFS rates were 82% (74–92%) for the tumor-free laparoscopic RS group and 78% (69–89%) for the open RS group ( Table 3 – 4 ) . No statistically significant differences were observed in OS, PFS (including DMFS) between the surgical approaches ( Fig. 2 , Figure S3) . Furthermore, among patients with consistent FIGO staging before and after surgery, comparison between the tumor-free laparoscopic and open RS groups also showed no statistically significant difference in PFS (Figure S4) . OS could not be compared in this subgroup due to the small sample size (9 patients per group) and the absence of death events. Additionally, we separately compared the survival outcomes between the laparoscopic group versus the CCRT group and between the open surgery group versus the CCRT group after PSM, and found no significant differences in both PFS and OS (Figure S5-6) . Patient quality of life across different treatment strategies and surgical approaches after propensity score matching After the comparison of survival outcomes across groups, we further investigated the differences in QoL among them. Notably, the RS and definitive CCRT groups exhibited distinct profiles of specific AEs. Patients in the CCRT group had significantly higher incidences of hematological toxicities, including leukopenia/neutropenia (38.30% vs. 10.53%, p < 0.001), thrombocytopenia (31.91% vs. 2.63%, p < 0.001), and anemia (31.91% vs. 2.63%, p < 0.001). In contrast, complications such as intestinal obstruction (2.63%) and chronic genitourinary sequelae (e.g., hydronephrosis, bladder dysfunction, vesicovaginal fistula) were exclusively observed in the RS group ( Table 3 ) . Within the RS group, the open approach was associated with a significantly higher rate of leukopenia/neutropenia compared to the tumor-free laparoscopic approach (21.74% vs. 1.45%, p = 0.001). The differing nature and mechanisms of AEs between RS and CCRT complicate direct comparison [ 21 , 22 ]. To address this, we further assessed the comprehensive prognosis of patients using QALYs, which integrate both survival duration and QoL ( Fig. 3 ) . By assigning utility values to different health states (Recurrence and AEs), we calculated two-year QALYs for different treatment strategies and surgical approaches after PSM. No significant difference in QALYs was observed between the RS group (23.55 [22.54, 24.00]) and the definitive CCRT group (23.53 [22.60, 23.80]; w = 3148, p = 0.074), suggesting comparable QALYs between these two treatment modalities, while statistically significant differences were found between different surgical strategies (tumor-free laparoscopic RS: 24.00 [23.52, 24.00]; open RS: 23.52[21.77, 24.00]; w = 3060, p = 0.003), indicating that tumor-free laparoscopic surgery was associated with better QALYs over the two-year follow-up period compared to open surgery. Notably, the QALY months in the tumor-free laparoscopic RS group were more tightly distributed than those in the open RS group, suggesting greater consistency in QoL outcomes and better predictability of treatment effects for tumor-free laparoscopic surgery compared to open surgery. Subgroup analysis and sensitivity analysis To further assess the robustness of our findings, we performed subgroup analyses of patients stratified by treatment strategy in the PSM cohort. Remarkably, no statistically significant differences were observed in OS or PFS between the compared treatment strategies (RS group vs. the CCRT group; tumor-free laparoscopic RS vs. open RS) within any of the subgroups ( Fig. 4 ) . We also conducted a sensitivity analysis by altering the PSM ratio from 1:3 to 1:2. The results remained consistent, with no significant changes observed in the primary outcomes. The detailed results of the sensitivity analysis are provided in the Supplementary Materials (Figure S7) . DISCUSSION This prospective multicenter cohort study, which employed PSM analysis, demonstrated that RS provided non-inferior survival outcomes and two-year QALYs compared to CCRT in specific LACC patients (FIGO 2018 stages IB3, IIA2, or IIICr). Furthermore, tumor-free laparoscopic RS yielded comparable survival outcomes and superior two-year QALYs versus open RS within the surgical cohort, supporting its feasibility as an alternative when adhering to strict tumor-free principles. The NCCN guidelines designate CCRT as the preferred option (Category 1 evidence) for LACC patients, with RS relegated to a Category 2B recommendation. Nevertheless, several retrospective studies have suggested that surgical management may provide non-inferior survival outcomes [ 4 – 7 ]. Specifically, Doll et al.[ 4 ] found that although 88% of patients receiving RS were supplemented with adjuvant therapy, the 5-year survival rate of the surgery group was higher than that of the non-surgery group. Rungruang et al.[ 5 ] also showed that OS was shorter in those with radiotherapy than in those with RS as the primary treatment. Similar to the conclusions of these retrospective studies, our results demonstrate that RS achieves non-inferior oncologic outcomes (OS, PFS, or DMFS) compared to definitive CCRT in preoperative specific LACC patients. Moreover, in RS patients with consistent preoperative and postoperative FIGO staging, OS and PFS were comparable to the CCRT group. Subgroup analyses further revealed no significant prognostic heterogeneity across age strata, FIGO stages, tumor diameter categories, or department of surgery regarding treatment modality impacts on survival outcomes. Regarding QoL in specific LACC patients, no significant differences in two-year QALYs were observed between the RS and definitive CCRT groups, further supporting their clinical equivalence. Therefore, our multicenter, prospective data preliminarily demonstrate that for specific LACC patients (FIGO 2018 stages IB3, IIA2, or IIICr), initial treatment with RS is a safe and feasible approach. For LACC patients undergoing RS, the optimal surgical approach remains a critical clinical inquiry. The NCCN guidelines endorse open RS as the standard based on evidence from a phase III multicenter RCT [ 9 , 10 ]. However, the trial design has limitations, including modest surgeon experience (≥ 10 procedures) and substantial quality heterogeneity across the 33 participating centers. Notably, advancements in tumor-free laparoscopic instrumentation and refined surgical techniques suggest a potential systematic underestimation of the value of tumor-free laparoscopic oncology [ 11 , 12 ]. Furthermore, several retrospective analyses have demonstrated the therapeutic equivalence and safety of laparoscopic radical surgery [ 13 – 18 , 23 – 26 ]. Specifically, a retrospective study including CC patients (stages IA–IIIC) showed no significant difference in the laparoscopic RS, abdominal RS, and laparoscopic nerve-sparing ultra-radical hysterectomy (LNSURH) groups, respectively (DFS: 87.9% vs. 82.6% vs. 91.7%, p = 0.302; OS: 97.0% vs. 95.7% vs. 98.6%, p = 0.553) [ 18 ]. In patients with stage IB3 or IIA2 CC, Yang et al. reported comparable survival between Laparoscopic Radical Hysterectomy with Karez technique (LRH-Karez) and Abdominal Radical Hysterectomy (ARH), with 5-year OS (92.2% vs. 78.3%; P = 0.218) and PFS (85% vs. 78.3%; P = 0.898) rates, respectively [ 26 ]. In our cohort focusing on specific LACC patients (FIGO 2018 stages IB3, IIA2, or IIICr), we established stringent criteria for both surgeon qualifications and corresponding oncological surgical procedures. Our results further validated the non-inferiority of laparoscopic surgery performed by certified surgeons under tumor-free principles in terms of OS, PFS, and DMFS. Among patients with consistent preoperative and postoperative FIGO staging, PFS was comparable between the tumor-free laparoscopic and open RS groups. Notably, the tumor-free laparoscopic RS group showed significantly better and more tightly distributed two-year QALY than the open RS group (w = 3060, p = 0.003). This study provides evidence that when performed by surgeons meeting stringent credentialing criteria, tumor-free laparoscopic surgery (Peritoneal Irrigation; Secure Ligation) achieves comparable oncologic outcomes to open surgery in specific LACC patients. Our conclusions have several limitations. First, most surgical patients were recruited from a single center, which may introduce selection bias. Treatment selection was based on clinical decision-making, potentially introducing bias that PSM can only partially mitigate by addressing observed confounders. Second, the relatively short follow-up period limited the number of observed events (recurrence or death). Finally, further randomized controlled trials and long-term survival data for specific LACC subtypes (FIGO 2018 stages IB3, IIA2, or IIICr) are warranted to construct and validate a robust survival scoring model. Our study demonstrates that in specific LACC cases (FIGO 2018 stages IB3, IIA2, or IIICr), RS therapy yields survival outcomes (OS, PFS, and two-year QALYs) comparable to those achieved with definitive CCRT. Furthermore, tumor-free laparoscopic surgery was non-inferior to open surgery in terms of PFS and OS, while also associated with superior two-year QALYs. This multicenter, prospective cohort study advances the understanding of precision therapy for specific LACC (FIGO 2018 stages IB3, IIA2, or IIICr) and provides clinically relevant, real-world evidence from a Chinese population. Abbreviations CCRT, concurrent chemoradiotherapy LACC, specific locally advanced cervical cancer OS, overall survival PFS, progression-free survival AEs, adverse events QALYs, quality-adjusted life years PSM, Propensity score matching QoL, quality of life DFS, disease-free survival RH, radical hysterectomy BS, bilateral salpingectomy PLD, pelvic lymphadenectomy PALD, para-aortic lymphadenectomy DMFS, Distant metastasis-free survival HRs, hazard ratios FDR, false discovery rate SMDs, standardized mean differences LNSURH, laparoscopic nerve-sparing ultra-radical hysterectomy LRH-Karez, Laparoscopic Radical Hysterectomy with Karez technique ARH, Abdominal Radical Hysterectomy Declarations Ethics approval and consent to participate This protocol has received approval from the Ethics Committees of the Obstetrics and Gynecology Hospital of Fudan University (No. 2021-12), Fudan University Shanghai Cancer Center (No. 2209260-24), and The Sixth Hospital of Shanghai Jiao Tong University School of Medicine (No. 2022-KY-150 (K)). The trial will adhere to Good Clinical Practice (GCP) standards and be conducted following the principles outlined in the World Medical Association’s Declaration of Helsinki. Written informed consent were obtained from all participants. Consent for publication Not applicable Availability of data and materials The data that support the findings of this study are available from the corresponding author upon reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This project was supported by funding from Medical Innovation Research of Shanghai Science and Technology (22Y31900500), and Shanghai Hospital Development Center (SHDC2020CR6009, SHDC2020CR1045B, SHDC22021307 and SHDC2020CR4087); Medical Innovation Research of Shanghai Science and Technology (21Y 11906900), the Eastern Talent Plan Project, the Simulated RCT study of Shanghai Shenkang Hospital Development Center (SHDC2024CRI060), and Huangpu Youth Talent Project. Provenance and peer review Not commissioned, externally peer-reviewed. Authors' contributions Q.L. and J.Q. conceived and designed the study. Q.L., S.S., Y.H., Y.L., and L.J. were responsible for patient sample and data collection. W.L., Q.L., and Y.D. designed the analytical approach, performed data analysis, and interpreted the results. Q.L., W.L., J.Q., X.Q., and Y.Y. drafted the manuscript and critically revised it for important intellectual content. Q.L. and W.L. contributed to figure preparation. J.Q., Y.Y., J.F., and K.H. supervised the study. Q.L. and J.Q. had full access to all study data. All authors have read and approved the final manuscript. Each author agrees to be personally accountable for their contributions and for ensuring that questions regarding the accuracy or integrity of any part of the work are appropriately investigated and resolved. Acknowledgements Not applicable References Sung H, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–49. Serkies K, Jassem J. Systemic therapy for cervical carcinoma - current status. Chin J Cancer Res. 2018;30(2):209–21. Qiu J, et al. A comparison of concurrent chemoradiotherapy and radical surgery in patients with specific locally advanced cervical cancer (stage IB3, IIA2, IIICr): trial protocol for a randomized controlled study (C-CRAL trial). J Gynecol Oncol. 2023;34(5):e64. Doll KM, et al. Radical hysterectomy compared with primary radiation for treatment of stage IB1 cervix cancer. Am J Clin Oncol. 2014;37(1):30–4. Rungruang B, et al. Surgery versus radiation therapy for stage IB2 cervical carcinoma: a population-based analysis. Int J Gynecol Cancer. 2012;22(3):484–9. Yin M, et al. The long-term efficacy of neoadjuvant chemotherapy followed by radical hysterectomy compared with radical surgery alone or concurrent chemoradiotherapy on locally advanced-stage cervical cancer. Int J Gynecol Cancer. 2011;21(1):92–9. Yang J, et al. Comparing survival outcomes between surgical and radiographic lymph node assessment in locally advanced cervical cancer: A propensity score-matched analysis. Gynecol Oncol. 2020;156(2):320–7. Wang JD, Kong WM, Jiang H. [FIGO 2018 staging of cervical cancer and related issues]. Zhonghua Zhong Liu Za Zhi, 2020. 42(2): pp. 94–98. Ramirez PT, et al. Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer. N Engl J Med. 2018;379(20):1895–904. Melamed A, et al. Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer. N Engl J Med. 2018;379(20):1905–14. Huang Y, et al. Survival after laparoscopic radical surgery for stage IA-IIB cervical cancer: 1316 consecutive cases from a national laparoscopic training center in China. Int J Clin Oncol. 2023;28(1):175–83. Lv X, et al. Effect of modified radical laparoscopic hysterectomy versus open radical hysterectomy on short-term clinical outcomes in early-stage cervical cancer: a single-center, prospective, randomized controlled trial. World J Surg Oncol. 2023;21(1):167. Ceccaroni M, et al. Total laparoscopic vs. conventional open abdominal nerve-sparing radical hysterectomy: clinical, surgical, oncological and functional outcomes in 301 patients with cervical cancer. J Gynecol Oncol. 2021;32(1):e10. Wang W, et al. Laparoscopic vs. Abdominal Radical Hysterectomy for Locally Advanced Cervical Cancer. Front Oncol. 2019;9:1331. Yuan Z, et al. Laparoscopic vs. Open Abdominal Radical Hysterectomy for Cervical Cancer: A Single-Institution, Propensity Score Matching Study in China. Front Oncol. 2019;9:1107. Chen C, et al. Comparison of survival outcomes between laparoscopic surgery and abdominal surgery for radical hysterectomy as primary treatment in patients with stage IB2/IIA2 cervical cancer. J Obstet Gynaecol Res. 2021;47(4):1516–26. Zhao W, et al. Survival Outcomes in Patients With 2018 FIGO Stage IA2-IIA2 Cervical Cancer Treated With Laparoscopic Versus Open Radical Hysterectomy: A Propensity Score-Weighting Analysis. Front Oncol. 2021;11:682849. Wei WW, et al. Survival Impacts of Perineural Invasion on Patients Under Different Radical Hysterectomies Due to Early Cervical Cancer. Front Oncol. 2022;12:889862. Riaz A. A., Revised Strengthening the Reporting of Cohort, Cross-Sectional and Case-Control Studies in Surgery (STROCSS) Guideline: An Update for the Age of Artificial Intelligence. Premier J Sci, 2025. 2. Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat. 2011;10(2):150–61. Burke TW. Treatment Options in Stage IB Cervical Cancer: Radical Hysterectomy and Radiotherapy. Semin Radiat Oncol. 1994;4(1):34–40. Photopulos GJ. Surgery or radiation for early cervical cancer. Clin Obstet Gynecol. 1990;33(4):872–82. Wang W, et al. Long-Term Oncological Outcomes After Laparoscopic Versus Abdominal Radical Hysterectomy in Stage IA2 to IIA2 Cervical Cancer: A Matched Cohort Study. Int J Gynecol Cancer. 2016;26(7):1264–73. Park JY, et al. Laparoscopic versus open radical hysterectomy in patients with stage IB2 and IIA2 cervical cancer. J Surg Oncol. 2013;108(1):63–9. Nam JH, et al. Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study. Ann Oncol. 2012;23(4):903–11. Yang X, et al. Laparoscopic radical hysterectomy with Karez technique for stage IB3 and IIA2 cervical cancer: a multicenter retrospective cohort study. Int J Surg. 2025;111(7):4516–27. Insinga RP, et al. Cost-effectiveness of pembrolizumab in combination with chemotherapy versus chemotherapy and pembrolizumab monotherapy in the first-line treatment of squamous non-small-cell lung cancer in the US. Curr Med Res Opin. 2019;35(7):1241–56. Zheng Z, et al. Cost-effectiveness analysis of pembrolizumab plus chemotherapy for patients with recurrent or metastatic cervical cancer in China. Curr Med Res Opin. 2023;39(3):433–40. Cai H, et al. Atezolizumab plus bevacizumab and chemotherapy versus bevacizumab plus chemotherapy for metastatic cervical cancer: a cost-effectiveness analysis. Front Pharmacol. 2024;15:1476256. Lesnock JL, et al. Upfront treatment of locally advanced cervical cancer with intensity modulated radiation therapy compared to four-field radiation therapy: a cost-effectiveness analysis. Gynecol Oncol. 2013;129(3):574–9. Additional Declarations No competing interests reported. Supplementary Files supplementary.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 07 May, 2026 Reviews received at journal 20 Apr, 2026 Reviewers agreed at journal 20 Apr, 2026 Reviews received at journal 17 Apr, 2026 Reviewers agreed at journal 16 Apr, 2026 Reviewers invited by journal 02 Apr, 2026 Editor assigned by journal 02 Apr, 2026 Editor invited by journal 26 Mar, 2026 Submission checks completed at journal 26 Mar, 2026 First submitted to journal 26 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9161019","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":618290944,"identity":"5b7cb14c-3e22-4220-a182-5946efd2be92","order_by":0,"name":"Qinqin Liu","email":"","orcid":"","institution":"Obstetrics and Gynecology Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Qinqin","middleName":"","lastName":"Liu","suffix":""},{"id":618290945,"identity":"562f33e3-4ca5-4586-ab71-19bd851efbbe","order_by":1,"name":"Wenwen Liu","email":"","orcid":"","institution":"Fudan 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15:23:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9161019/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9161019/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106725031,"identity":"47d01890-145e-432a-8dd4-42658a7b20e0","added_by":"auto","created_at":"2026-04-12 18:31:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":447125,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePatient enrollment flowchart across different treatment groups in the multicenter cohort\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-9161019/v1/105a7f61d03a01cc39ce51ff.png"},{"id":106725049,"identity":"93cf2122-eac5-49f1-ab67-ef2b90fa5934","added_by":"auto","created_at":"2026-04-12 18:31:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":322931,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKaplan-Meier analysis of OS and PFS in two treatment strategies and two surgical approaches after PSM\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter 1:3 PSM for the two treatment strategies and 1:1 PSM for the two surgical approaches, no significant differences in OS or PFS were observed between the RS and the definitive CCRT groups, or between the tumor-free laparoscopic RS and the open RS groups.\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-9161019/v1/f2f61a0e2d8801350c984e47.png"},{"id":106534374,"identity":"f726c699-8c9d-4fb8-8d3f-567e4bf84d7a","added_by":"auto","created_at":"2026-04-09 15:03:22","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":632991,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of QALYs in two treatment strategies and two surgical approaches after PSM\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter 1:3 PSM for the two treatment strategies and 1:1 PSM for the two surgical approaches, the Wilcoxon rank-sum test was used to compare two-year QALYs. The results showed no significant difference in QALYs between the RS and the definitive CCRT groups, while the tumor-free laparoscopic RS group had significantly longer QALYs than the open RS group.\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-9161019/v1/3529f75fce0dd954cea8f78d.png"},{"id":106534376,"identity":"018e6aad-9c39-4931-a660-dcbb5156c7a0","added_by":"auto","created_at":"2026-04-09 15:03:22","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":379449,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSubgroup analysis of OS and PFS in two treatment strategies and two surgical approaches after PSM\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter 1:3 PSM for the two treatment strategies and 1:1 PSM for the two surgical approaches, subgroup analyses were performed according to age, maximum tumor diameter, FIGO stage, and department of surgery. For continuous variables including age and maximum tumor diameter, the median values of the study population were utilized as cut-off points for subgroup classification. Interaction p values were derived from Cox proportional hazards models including interaction terms between subgroup variables and treatment (or surgical approach). Multiple testing was adjusted using the false discovery rate (FDR) method, with corresponding q values reported. The results showed no significant differences in OS or PFS between the RS and the definitive CCRT groups, or between the tumor-free laparoscopic RS and the open RS groups. (No relevant events occurred or the sample size was too small to allow meaningful comparisons.)\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-9161019/v1/e84f13e7a2b322abb16a37cd.png"},{"id":106727159,"identity":"733adb2b-0ba7-4486-83fe-2cba343391c2","added_by":"auto","created_at":"2026-04-12 18:38:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3788888,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9161019/v1/96dbd347-e972-4137-9a65-6d3cd9de1603.pdf"},{"id":106534372,"identity":"04ae0a2c-a245-4ae9-94f6-d1e6a2167e15","added_by":"auto","created_at":"2026-04-09 15:03:22","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":6427282,"visible":true,"origin":"","legend":"","description":"","filename":"supplementary.docx","url":"https://assets-eu.researchsquare.com/files/rs-9161019/v1/47928ccbd85617bce7a3432f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Effectiveness of Radical Surgery versus Concurrent Chemoradiotherapy in Stage IB3, IIA2, or IIICr Cervical Cancer: A Prospective, Multicenter, Propensity Score-Matched Cohort Study","fulltext":[{"header":"HIGHLIGHTS","content":"\u003cp\u003e\u003cstrong\u003eComparable Efficacy of Radical Surgery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRS achieved equivalent OS, PFS, and 2-year QALYs compared to definitive CCRT in specific LACC patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNon-Inferiority of Laparoscopic Approach\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen adhering to tumor-free principles, laparoscopic RS provided equivalent oncologic outcomes to open surgery, while also being associated with superior 2-year QALYs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEvidence for Personalized Treatment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis prospective cohort study provides high-level evidence to guide personalized clinical decision-making, supporting both RS as an alternative to CCRT and a laparoscopic approach for specific LACC patients.\u003c/p\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eCervical cancer (CC) is a major global health concern and the fourth leading cause of cancer-related death in women worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In China, inadequate cervical screening leads to 40\u0026ndash;60% of patients being diagnosed with locally advanced cervical cancer (LACC; FIGO 2018 stages IB3\u0026ndash;IVA) at initial presentation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The optimal treatment for specific LACC stages (FIGO 2018 stages IB3, IIA2, or IIICr) remains controversial. Although the NCCN 2025 guidelines recommend concurrent chemoradiotherapy (CCRT) as a Category 1 preferred treatment, radical surgery (RS), which is categorized as a 2B option, remains widely used in clinical practice in China. This preference reflects uneven radiotherapy resources, limitations in imaging-based staging accuracy, and strong patient inclination toward surgical resection [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRS provides distinct advantages, including effective cytoreduction and accurate histopathological staging to guide adjuvant therapy. Retrospective analyses have demonstrated superior survival outcomes in surgical cohorts compared to non-operative management [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Nevertheless, the substantial tumor burden of LACC poses technical challenges during surgery. Moreover, the frequent occurrence of high- or intermediate-risk pathological features often necessitates adjuvant therapy. This therapeutic overlap may increase treatment-related morbidity and adversely affect quality of life (QoL) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Therefore, prospective investigations with large-scale cohorts from multiple centers are needed to provide higher-level evidence for the standardization of surgical strategies in LACC.\u003c/p\u003e \u003cp\u003eRecent studies have raised serious concerns about the oncologic safety of laparoscopic surgery for CC, highlighting a significant increase in recurrence rates and prompting a re-evaluation of its role in treatment. The landmark phase III multicenter Laparoscopic Approach to Cervical Cancer trial demonstrated that minimally invasive surgery was linked to lower disease-free survival (DFS) compared to open surgery in women with early-stage CC [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, the RCT\u0026rsquo;s requirement of only 10 laparoscopic procedures per surgeon may be insufficient to achieve the necessary proficiency for type C RH according to the Querleu-Morrow classification. Moreover, advancements in laparoscopic techniques and growing surgical experience have enhanced its effectiveness over time [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Thus, the conclusions of the Laparoscopic Approach to LACC may not be applicable. To date, only a few studies have compared surgical and oncologic outcomes between laparoscopic and abdominal RS in LACC patients [\u003cspan additionalcitationids=\"CR14 CR15 CR16 CR17\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. These studies have shown that there is no significant difference in prognosis between laparoscopic and open surgery when using the Non-touch Isolation Technique. However, the small sample size and retrospective design of these studies limit their conclusions\u0026rsquo; further application.\u003c/p\u003e \u003cp\u003eTo bridge these evidence gaps, we conducted a prospective multicenter cohort study comparing prognosis and QoL in specific LACC patients (FIGO 2018 stages IB3, IIA2, or IIICr) undergoing one of three treatments: (i) open RS (Arm A1), (ii) tumor-free laparoscopic RS (Arm A2), or (iii) definitive CCRT (Group B). Propensity score matching (PSM) was applied to minimize confounding between treatment groups, and the study aims to provide high-level prospective evidence to help expand therapeutic options for this patient population.\u003c/p\u003e \u003cp\u003eThis cohort study has been reported in line with the STROCSS guidelines [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and patients\u003c/h2\u003e \u003cp\u003eThis multicenter cohort study aimed to compare the overall survival (OS), progression-free survival (PFS), adverse events (AEs), and two-year QALYs between the RS and the definitive CCRT in specific LACC patients (FIGO 2018 stages IB3, IIA2, or IIICr), evaluating differences between tumor-free laparoscopic and open radical approaches within the RS group. We analyzed patients diagnosed with specific LACC between April 2020 and December 2022 at three tertiary teaching hospitals in Shanghai, China.\u003c/p\u003e \u003cp\u003eInclusion criteria: (1) Aged 18\u0026ndash;70 years; (2) Clinically diagnosed with specific LACC (FIGO 2018 stages IB3, IIA2, or IIICr); (3) Underwent RS or received definitive CCRT.\u003c/p\u003e \u003cp\u003eExclusion criteria: (1) History of prior chemotherapy or radiotherapy; (2) Pregnancy or a history of other malignancies; (3) Evidence of distant metastasis on imaging.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTreatments and Follow-up\u003c/h3\u003e\n\u003cp\u003eThe surgical protocol for Group A (RS cohort) consisted of two standardized approaches: open RS (Arm A1) and tumor-free laparoscopic RS (Arm A2). Both arms involved the same surgical procedures: radical hysterectomy (RH), bilateral salpingectomy (BS), with or without oophorectomy, pelvic lymphadenectomy (PLD), with or without para-aortic lymphadenectomy (PALD).\u003c/p\u003e \u003cp\u003eTo ensure strict adherence to tumor-free principles during RS, several key measures have been implemented:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e\u003cb\u003ePeritoneal Irrigation\u003c/b\u003e Cisplatin and hypotonic sterile water were used during RH to minimize the risk of tumor dissemination.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e\u003cb\u003eSecure Ligation\u003c/b\u003e The vagina beneath the cervical lesion was ligated before uterus removal, with cisplatin irrigation applied both before and after ligation, ensuring the hysterectomy specimen remained intact.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eAll the surgeries will be performed by qualified and experienced surgeons with certificates to perform RH, PLD, and PALD. Moreover, participating surgeons have an annual volume of more than 50 cases of RH, PLD, and PALD.\u003c/p\u003e \u003cp\u003e Participants who receive definitive CCRT (group B) will receive treatment following NCCN radiation therapy guidelines.\u003c/p\u003e \u003cp\u003eFollow-up assessments were conducted through telephone interviews and outpatient visits. The last follow-up was conducted in September 2024. We will conduct standardized postoperative follow-ups strictly following the NCCN guidelines every three months for two years, every six months for another three years, and then annually. All follow-up investigators underwent rigorous training to ensure data accuracy and consistency. Additional treatment details and follow-up procedures are provided in \u003cb\u003eTable \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e-4\u003c/b\u003e.\u003c/p\u003e\n\u003ch3\u003eData collection and survival outcomes\u003c/h3\u003e\n\u003cp\u003ePatients\u0026rsquo; information, including age, histological type, maximum tumor diameter, FIGO stage, tumor invasion and metastasis status, and specific treatment modalities, was collected at the time of cohort enrollment. The primary outcomes of interest included PFS and OS, with secondary endpoints including treatment-related AEs and two-year QALY assessments.\u003c/p\u003e \u003cp\u003eOS was defined as the interval from the date of enrollment to death from any cause. PFS was defined as the time from enrollment to the first documentation of disease progression or death from any cause. Distant metastasis-free survival (DMFS) was calculated from the date of treatment initiation (either radical surgery or the first session of CCRT) to the first evidence of distant metastasis or death from any cause, whichever occurred first. Distant metastasis was defined as any tumor recurrence outside the pelvis or beyond the regional lymph nodes, as confirmed by clinical assessment and imaging modalities (e.g., CT, MRI, or PET-CT) according to the RECIST 1.1 criteria. For all endpoints, patients who were alive and event-free at the time of the last follow-up were censored at the date of their last contact.\u003c/p\u003e \u003cp\u003eTo evaluate patients\u0026rsquo; QoL, we estimated QALYs over a two-year horizon by assigning utility values to specific health states. Health states included treatment-related AEs (leukopenia/neutrophil reduction, thrombocytopenia, anemia, diarrhea, nausea/vomiting, intestinal fistula, chronic gastrointestinal complications, and chronic genitourinary complications) as well as recurrence/progression. The corresponding utility values, ranging from 0.50 to 0.98, were derived from previously published literature \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e QALYs were calculated as the sum of time spent in each health state multiplied by its respective utility value:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUtility values assigned to health states for QALY calculation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth state\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUtility value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSource\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeukopenia/Neutrophil reduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLiterature[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThrombocytopenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLiterature[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLiterature[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLiterature[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea/Vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLiterature [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntestinal fistula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLiterature[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic gastrointestinal complications \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLiterature [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic genitourinary complications \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLiterature [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecurrence/Progression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLiterature [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eQALY = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\sum\\:_{i\\:=\\:1}^{n}(\\:{Utility}_{i}\\times\\:{Time}_{i}\\:\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003ea\u003c/sup\u003e Including intestinal obstruction and rectovaginal fistula\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003eb\u003c/sup\u003e Including hydronephrosis, bladder dysfunction, and vesicovaginal fistula\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"data:image/png;base64,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\" width=\"333\" height=\"37\"\u003e\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003ePropensity scores for each patient were generated using logistic regression analysis, incorporating the covariates of age, histological type, maximum tumor diameter, FIGO stage, and lymph node metastasis. PSM was applied at a 1:3 ratio to compare patients who received definitive CCRT with those who underwent RS primarily, using a caliper width of 0.2 times the standard deviation of the logit of the propensity score [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. To analyze the prognosis of patients undergoing tumor-free laparoscopic RS and open RS, PSM was applied at a 1:1 ratio.\u003c/p\u003e \u003cp\u003eAfter matching, the primary comparisons focused on OS, PFS (including DMFS), AEs, and two-year QALYs between the following groups: (i) RS and definitive CCRT, and (ii) tumor-free laparoscopic RS and open RS. In addition, matched pair analyses were performed to further evaluate prognostic outcomes between (a) RS patients with consistent preoperative and postoperative FIGO staging and matched CCRT patients, (b) open RS and matched CCRT patients, and (c) laparoscopic RS and matched CCRT patients.\u003c/p\u003e \u003cp\u003eBaseline characteristics were compared between the treatment groups using the t-test, chi-square test, and Fisher\u0026rsquo;s exact test, as appropriate. Survival outcomes were estimated using the Kaplan-Meier method and compared with the log-rank test. The Wilcoxon rank-sum test was used to compare two-year QALYs both across treatment strategies and across surgical approaches within the RS group. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and conduct subgroup analyses stratified by age, maximum tumor diameter, FIGO stage, and surgeon\u0026rsquo;s department in the PSM cohort. Interaction effects between subgroup variables and treatment strategies (or surgical approaches) were assessed by including interaction terms in the Cox models, and corresponding p values for interaction were calculated. To account for multiple subgroup comparisons, the false discovery rate (FDR) method was applied, and adjusted q values were reported. Sensitivity analyses were performed by repeating PSM at a 1:2 ratio for RS therapy versus definitive CCRT.\u003c/p\u003e \u003cp\u003eAll statistical analyses were conducted using R version 4.3.1.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eParticipant characteristics\u003c/h2\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, 246 patients were included in this study, among whom 198 patients were in the RS and 48 patients were in the definitive CCRT group. Of the RS group, 119 received tumor-free laparoscopic surgery and 79 underwent open surgery. Baseline patient characteristics before PSM are summarized in \u003cb\u003eTable S5\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePSM was performed based on pretreatment characteristics, including age, histological type, radiologically suggested maximum tumor diameter, FIGO stage, and lymph node metastasis status, to balance patients receiving different treatment strategies (RS vs. definitive CCRT) and surgical approaches (tumor-free laparoscopic RS vs. open RS). These resulted in matched cohorts of 114 RS patients versus 47 CCRT patients for comparative effectiveness analysis, and 69 patients per group for surgical outcomes comparison. Post-PSM assessment confirmed well-balanced baseline characteristics between both paired cohorts, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. All variables showed no statistically significant differences.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics after propensity score matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"15\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eTreatment strategy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c15\" namest=\"c11\"\u003e \u003cp\u003eSurgical approach\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRadical surgery (RS) group\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;114)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eDefinitive CCRT\u003c/b\u003e \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003cb\u003egroup (n\u0026thinsp;=\u0026thinsp;47)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003et/\u003c/b\u003eχ\u003csup\u003e2\u003c/sup\u003e/Z\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003ep value\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e\u003cb\u003eTumer-free laparoscopic RS group (n\u0026thinsp;=\u0026thinsp;69)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003eOpen RS group (n\u0026thinsp;=\u0026thinsp;69)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e\u003cb\u003et/\u003c/b\u003eχ\u003csup\u003e2\u003c/sup\u003e/Z\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e \u003cp\u003e\u003cb\u003ep value\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (median [IQR])\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e55 [48, 60]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53 [49, 61]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2719.500 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e52 [44, 58]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e52 [46, 59]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2417.000 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.878\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistological type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSquamous cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e96.49% (110/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95.74% (45/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e89.86% (62/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e88.41% (61/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdenosquamous carcinoma/ Adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e3.51% (4/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.26% (2/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e10.14% (7/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e11.59% (8/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaximum tumor diameter, cm\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e6.30 [5.10, 6.80]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.80 [4.45, 6.90]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3103.500 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e6.60 [5.60, 7.30]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6.70 [5.77, 7.47]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2265.000 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.624\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFIGO stage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.089 \u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.929\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.129 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.988\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI B3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e8.77% (10/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.38% (3/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e15.94% (11/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e17.39% (12/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII A2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e21.93% (25/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.15% (9/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e26.09% (18/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e27.54% (19/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII C1R\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e59.65% (68/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65.96% (31/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e50.72% (35/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e47.83% (33/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII C2R\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e9.65% (11/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.51% (4/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e7.25% (5/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7.25% (5/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFIGO stage\u003c/b\u003e III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.527 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.552 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.458\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum tumor diameter\u0026thinsp;\u0026le;\u0026thinsp;4 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e15.19% (12/79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.86% (8/35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e10.00% (4/40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e18.42% (7/38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum tumor diameter\u0026thinsp;\u0026gt;\u0026thinsp;4 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e84.81% (67/79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e77.14% (27/35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e90.00% (36/40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e81.58% (31/38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedically managed comorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e17.54% (20/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.02% (8/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e15.94% (11/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8.70% (6/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.073 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.300\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e8.77% (10/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.89% (7/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.110 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e4.35% (3/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7.25% (5/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.361 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.718\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e13.16% (15/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.89% (7/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.969\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e14.49% (10/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e18.84% (13/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.209 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.648\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImaging-detected lymph node metastasis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e69.30% (79/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74.47% (35/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.217 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.642\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e57.97% (40/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e55.07% (38/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.029 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.864\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePelvic lymph nodes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e12.28% (14/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.28% (10/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.473 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e13.04% (9/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8.70% (6/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.299 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.584\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParametrial nodes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e5.26% (6/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.51% (4/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.706 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.480\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e4.35% (3/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.45% (1/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.496 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.620\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIliac lymph nodes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e55.26% (63/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55.32% (26/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e46.38% (32/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e43.48% (30/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.029 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.864\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetroperitoneal nodes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e4.39% (5/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.89% (7/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.044 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.041\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e2.90% (2/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.80% (4/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.411 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.681\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParaaortic nodes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e8.77% (10/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.51% (4/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e7.25% (5/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7.25% (5/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCCRT treatment strategy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCRT\u0026thinsp;+\u0026thinsp;brachytherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97.87% (46/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.13% (1/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdjuvant therapy\u003c/b\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.085 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.932\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eChemoradiotherapy\u0026thinsp;+\u0026thinsp;brachytherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e19.30% (22/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e18.84% (13/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e15.94% (11/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemoradiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e76.31% (87/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e78.26% (54/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e81.16% (56/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo required\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e4.39% (5/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e2.90% (2/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2.90% (2/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDepartment of surgery\u003c/b\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.383 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.536\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGynecologic oncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e82.46% (94/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e75.36% (52/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e81.16% (56/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral gynecology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e17.54% (20/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e24.64% (17/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e18.84% (13/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgical procedure\u003c/b\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e37.72% (43/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumer-free laparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e62.28% (71/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePositive surgical margins\u003c/b\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e18.42% (21/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e18.84% (13/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e15.94% (11/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.050 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.822\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParametrial invasion\u003c/b\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.947 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.623\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e71.93% (82/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e68.11% (47/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e66.67% (46/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnilateral infiltration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e24.56% (28/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e26.09% (18/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e23.19% (16/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilateral infiltration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e3.51% (4/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e5.80% (4/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e10.14% (7/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePathological lymph node metastasis\u003c/b\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e55.26% (63/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e50.72% (35/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e50.72% (35/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePelvic lymph nodes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e24.56% (28/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e14.49% (10/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e33.33 (23/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e5.735 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParametrial nodes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e10.53% (12/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e7.25% (5/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e10.14% (7/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.091 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.763\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIliac lymph nodes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e44.74% (51/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e50.73% (35/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e26.09% (18/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e7.842 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.005\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObturator lymph nodes (OLNs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e2.63% (3/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7.25% (5/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParaaortic nodes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e14.91% (17/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e14.49% (1069)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e14.49% (1069)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLymphovascular space invasion (LVSI)\u003c/b\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.82% (91/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e73.91% (51/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e88.41% (61/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e3.839 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaximum tumor diameter, cm\u003c/b\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e4.65 [4.00, 5.40]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e5.00 [4.00, 6.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.50 [4.00, 5.50]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2603.500 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.340\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCervical stromal invasion\u003c/b\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.393 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.694\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuperficial invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e2.63% (3/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e2.90% (2/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.45% (1/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntermediate invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e7.80% (9/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e5.80% (4/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.35% (3/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeep invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e34.21% (39/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e39.13% (27/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e31.88% (22/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFull-thickness invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e55.26% (63/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e52.17% (36/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e62.32% (43/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerineural invasion\u003c/b\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e11.40% (13/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e13.04% (9/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e20.29% (14/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.835 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.361\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVaginal invasion\u003c/b\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.402 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.161\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e37.72% (43/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e49.27% (34/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e36.23% (25/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper third\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e57.89% (66/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e44.93% (31/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e60.87% (42/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle third\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e4.39% (5/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e5.80% (4/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2.90% (2/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"15\"\u003e\u003csup\u003ea\u003c/sup\u003e Wilcoxon rank-sum test \u003csup\u003eb\u003c/sup\u003e Chi-square test \u003csup\u003ec\u003c/sup\u003e Fisher's exact Test * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"15\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e Concurrent chemoradiotherapy \u003csup\u003e\u0026Dagger;\u003c/sup\u003e Surgical approaches and postoperative parameters in the radical hysterectomy group\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAfter matching, additional clinicopathological and treatment-related factors were compared between the tumor-free laparoscopic RS and open RS groups, including department of surgery, positive surgical margins, parametrial invasion, lymph node metastasis, LVSI status, maximum tumor diameter, cervical stromal invasion, perineural and vaginal invasion. No significant differences were observed. To further rigorously assess the balance of covariates after PSM, standardized mean differences (SMDs) were calculated. As shown in \u003cb\u003eTable S6\u003c/b\u003e, all SMDs for the matched variables were below 0.2, indicating that an excellent baseline balance was achieved between the groups. Importantly, based on postoperative pathology, among the patients in the RS group, 19.30% received adjuvant chemoradiotherapy combined with brachytherapy, while the majority (76.31%) received chemoradiotherapy alone. A small proportion (4.39%, 5/114) did not require adjuvant therapy. The baseline characteristics are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePrognosis in different treatment strategies and surgical approaches following propensity score matching\u003c/h3\u003e\n\u003cp\u003eAfter a median follow-up of 38 months (interquartile range, 24\u0026ndash;45) in the comparison of treatment strategies (RS vs. CCRT), the RS group experienced 9 death events (9/114) and 23 recurrence events (23/114). In comparison, the definitive CCRT group recorded 4 deaths (4/47) and 10 recurrence events (10/47). The two-year OS rates were 92% (86\u0026ndash;97%) for the RS group and 91% (82\u0026ndash;100%) for the definitive CCRT group, with two-year PFS rates of 79% (72\u0026ndash;87%) and 78% (66\u0026ndash;91%), respectively \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. No significant differences were observed in OS or PFS (including distant metastasis-free survival, DMFS) between the two strategies \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cb\u003eFigure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e)\u003c/b\u003e. Additionally, among patients in the RS group with consistent FIGO staging before and after surgery, comparison with the CCRT group also showed no statistically significant differences in OS or PFS (\u003cb\u003eFigure S2\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRecurrence and adverse effects after propensity score matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eTreatment strategy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c12\" namest=\"c9\"\u003e \u003cp\u003eSurgical approach\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRadical surgery (RS) group\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;114)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eDefinitive CCRT\u003c/b\u003e \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003cb\u003egroup (n\u0026thinsp;=\u0026thinsp;47)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003et/\u003c/b\u003eχ\u003csup\u003e2\u003c/sup\u003e/Z\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep value\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003eTumer-free laparoscopic RS group (n\u0026thinsp;=\u0026thinsp;69)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003eOpen RS group\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;69)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003et/\u003c/b\u003eχ\u003csup\u003e2\u003c/sup\u003e/Z\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003ep value\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRecurrence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral recurrence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.51% (4/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e2.90% (2/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5.80% (4/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.785 \u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-central recurrence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.88% (1/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e2.90% (2/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtraperitoneal lymph node metastasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.63% (3/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.26% (2/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.294 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5.80% (4/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistant recurrence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.67% (19/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.15% (9/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.243 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e17.39% (12/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e15.94% (11/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.043 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.835\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.13% (1/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdverse events\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeukopenia/Neutrophil reduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53% (12/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.30% (18/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.147 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e1.45% (1/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e21.74% (15/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e11.948 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.001 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThrombocytopenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.63% (3/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.91% (15/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.865 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e1.45% (1/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.90% (2/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 \u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.75% (2/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.66% (13/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.291 \u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e1.45% (1/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.45% (1/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 \u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.14% (7/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.51% (4/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.342 \u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e2.90% (2/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.35% (3/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 \u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea/Vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.88% (1/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.38% (3/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.780 \u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntestinal fistula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.13% (1/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.45% (1/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic gastrointestinal complications \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntestinal obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.63% (3/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e5.80% (4/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRectovaginal fistula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.13% (1/47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic genitourinary complications \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHydronephrosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.88% (1/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.45% (1/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBladder dysfunction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.53% (12/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e17.39% (12/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8.70% (6/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.686 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.194\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVesicovaginal fistula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.16% (15/114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e15.94% (11/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e10.14% (7/69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.669 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.413\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003e\u003csup\u003ea\u003c/sup\u003e Including intestinal obstruction and rectovaginal fistula \u003csup\u003eb\u003c/sup\u003e Including hydronephrosis, bladder dysfunction, and vesicovaginal fistula\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003e\u003csup\u003ec\u003c/sup\u003e Chi-square test \u003csup\u003ed\u003c/sup\u003e Fisher's exact Test * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e Concurrent chemoradiotherapy \u003csup\u003e\u0026Dagger;\u003c/sup\u003e Surgical approaches and postoperative parameters in the radical hysterectomy group\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSurvival Rates by Treatment Groups and surgery groups after propensity score matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOverall survival\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eProgression-free survival\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003etwo-year, % (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEvents/patients, No. (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003etwo-year, % (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEvents/patients, No. (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment strategy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadical surgery (RS) group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92 (86\u0026ndash;97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9/114 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79 (72\u0026ndash;87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23/114 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDefinitive CCRT \u003csup\u003e\u0026dagger;\u003c/sup\u003e group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (82\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4/47 (99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78 (66\u0026ndash;91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10/47 (213)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgical approach\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumer-free laparoscopic RS group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (93\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2/69 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82 (74\u0026ndash;92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12/69 (17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen RS group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (84\u0026ndash;98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6/69 (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78 (69\u0026ndash;89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14/69 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e Concurrent chemoradiotherapy\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAfter a median follow-up of 37 months (interquartile range, 23\u0026ndash;43 months) in the comparison between tumor-free laparoscopic and open RS groups, the tumor-free laparoscopic RS group recorded 6 deaths (6/69) and 16 disease recurrences (16/69), while the open RS group had 6 deaths (6/69) and 19 recurrences (19/69). The two-year OS rates were 97% (93\u0026ndash;100%) for the tumor-free laparoscopic RS group and 91% (84\u0026ndash;98%) for the open RS group. The two-year PFS rates were 82% (74\u0026ndash;92%) for the tumor-free laparoscopic RS group and 78% (69\u0026ndash;89%) for the open RS group \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. No statistically significant differences were observed in OS, PFS (including DMFS) between the surgical approaches \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cb\u003eFigure S3)\u003c/b\u003e. Furthermore, among patients with consistent FIGO staging before and after surgery, comparison between the tumor-free laparoscopic and open RS groups also showed no statistically significant difference in PFS \u003cb\u003e(Figure S4)\u003c/b\u003e. OS could not be compared in this subgroup due to the small sample size (9 patients per group) and the absence of death events.\u003c/p\u003e \u003cp\u003eAdditionally, we separately compared the survival outcomes between the laparoscopic group versus the CCRT group and between the open surgery group versus the CCRT group after PSM, and found no significant differences in both PFS and OS \u003cb\u003e(Figure S5-6)\u003c/b\u003e.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePatient quality of life across different treatment strategies and surgical approaches after propensity score matching\u003c/h2\u003e \u003cp\u003eAfter the comparison of survival outcomes across groups, we further investigated the differences in QoL among them. Notably, the RS and definitive CCRT groups exhibited distinct profiles of specific AEs. Patients in the CCRT group had significantly higher incidences of hematological toxicities, including leukopenia/neutropenia (38.30% vs. 10.53%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), thrombocytopenia (31.91% vs. 2.63%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and anemia (31.91% vs. 2.63%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, complications such as intestinal obstruction (2.63%) and chronic genitourinary sequelae (e.g., hydronephrosis, bladder dysfunction, vesicovaginal fistula) were exclusively observed in the RS group \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Within the RS group, the open approach was associated with a significantly higher rate of leukopenia/neutropenia compared to the tumor-free laparoscopic approach (21.74% vs. 1.45%, p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThe differing nature and mechanisms of AEs between RS and CCRT complicate direct comparison [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. To address this, we further assessed the comprehensive prognosis of patients using QALYs, which integrate both survival duration and QoL \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. By assigning utility values to different health states (Recurrence and AEs), we calculated two-year QALYs for different treatment strategies and surgical approaches after PSM. No significant difference in QALYs was observed between the RS group (23.55 [22.54, 24.00]) and the definitive CCRT group (23.53 [22.60, 23.80]; w\u0026thinsp;=\u0026thinsp;3148, p\u0026thinsp;=\u0026thinsp;0.074), suggesting comparable QALYs between these two treatment modalities, while statistically significant differences were found between different surgical strategies (tumor-free laparoscopic RS: 24.00 [23.52, 24.00]; open RS: 23.52[21.77, 24.00]; w\u0026thinsp;=\u0026thinsp;3060, p\u0026thinsp;=\u0026thinsp;0.003), indicating that tumor-free laparoscopic surgery was associated with better QALYs over the two-year follow-up period compared to open surgery. Notably, the QALY months in the tumor-free laparoscopic RS group were more tightly distributed than those in the open RS group, suggesting greater consistency in QoL outcomes and better predictability of treatment effects for tumor-free laparoscopic surgery compared to open surgery.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSubgroup analysis and sensitivity analysis\u003c/h2\u003e \u003cp\u003eTo further assess the robustness of our findings, we performed subgroup analyses of patients stratified by treatment strategy in the PSM cohort. Remarkably, no statistically significant differences were observed in OS or PFS between the compared treatment strategies (RS group vs. the CCRT group; tumor-free laparoscopic RS vs. open RS) within any of the subgroups \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWe also conducted a sensitivity analysis by altering the PSM ratio from 1:3 to 1:2. The results remained consistent, with no significant changes observed in the primary outcomes. The detailed results of the sensitivity analysis are provided in the Supplementary Materials \u003cb\u003e(Figure S7)\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis prospective multicenter cohort study, which employed PSM analysis, demonstrated that RS provided non-inferior survival outcomes and two-year QALYs compared to CCRT in specific LACC patients (FIGO 2018 stages IB3, IIA2, or IIICr). Furthermore, tumor-free laparoscopic RS yielded comparable survival outcomes and superior two-year QALYs versus open RS within the surgical cohort, supporting its feasibility as an alternative when adhering to strict tumor-free principles.\u003c/p\u003e \u003cp\u003e The NCCN guidelines designate CCRT as the preferred option (Category 1 evidence) for LACC patients, with RS relegated to a Category 2B recommendation. Nevertheless, several retrospective studies have suggested that surgical management may provide non-inferior survival outcomes [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Specifically, Doll et al.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] found that although 88% of patients receiving RS were supplemented with adjuvant therapy, the 5-year survival rate of the surgery group was higher than that of the non-surgery group. Rungruang et al.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] also showed that OS was shorter in those with radiotherapy than in those with RS as the primary treatment. Similar to the conclusions of these retrospective studies, our results demonstrate that RS achieves non-inferior oncologic outcomes (OS, PFS, or DMFS) compared to definitive CCRT in preoperative specific LACC patients. Moreover, in RS patients with consistent preoperative and postoperative FIGO staging, OS and PFS were comparable to the CCRT group. Subgroup analyses further revealed no significant prognostic heterogeneity across age strata, FIGO stages, tumor diameter categories, or department of surgery regarding treatment modality impacts on survival outcomes. Regarding QoL in specific LACC patients, no significant differences in two-year QALYs were observed between the RS and definitive CCRT groups, further supporting their clinical equivalence. Therefore, our multicenter, prospective data preliminarily demonstrate that for specific LACC patients (FIGO 2018 stages IB3, IIA2, or IIICr), initial treatment with RS is a safe and feasible approach.\u003c/p\u003e \u003cp\u003eFor LACC patients undergoing RS, the optimal surgical approach remains a critical clinical inquiry. The NCCN guidelines endorse open RS as the standard based on evidence from a phase III multicenter RCT [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eHowever, the trial design has limitations, including modest surgeon experience (\u0026ge;\u0026thinsp;10 procedures) and substantial quality heterogeneity across the 33 participating centers.\u003c/span\u003e Notably, advancements in tumor-free laparoscopic instrumentation and refined surgical techniques suggest a potential systematic underestimation of the value of tumor-free laparoscopic oncology [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Furthermore, several retrospective analyses have demonstrated the therapeutic equivalence and safety of laparoscopic radical surgery [\u003cspan additionalcitationids=\"CR14 CR15 CR16 CR17\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Specifically, a retrospective study including CC patients (stages IA\u0026ndash;IIIC) showed no significant difference in the laparoscopic RS, abdominal RS, and laparoscopic nerve-sparing ultra-radical hysterectomy (LNSURH) groups, respectively (DFS: 87.9% vs. 82.6% vs. 91.7%, p\u0026thinsp;=\u0026thinsp;0.302; OS: 97.0% vs. 95.7% vs. 98.6%, p\u0026thinsp;=\u0026thinsp;0.553) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In patients with stage IB3 or IIA2 CC, Yang et al. reported comparable survival between Laparoscopic Radical Hysterectomy with Karez technique (LRH-Karez) and Abdominal Radical Hysterectomy (ARH), with 5-year OS (92.2% vs. 78.3%; P\u0026thinsp;=\u0026thinsp;0.218) and PFS (85% vs. 78.3%; P\u0026thinsp;=\u0026thinsp;0.898) rates, respectively [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In our cohort focusing on specific LACC patients (FIGO 2018 stages IB3, IIA2, or IIICr), we established stringent criteria for both surgeon qualifications and corresponding oncological surgical procedures. Our results further validated the non-inferiority of laparoscopic surgery performed by certified surgeons under tumor-free principles in terms of OS, PFS, and DMFS. Among patients with consistent preoperative and postoperative FIGO staging, PFS was comparable between the tumor-free laparoscopic and open RS groups. Notably, the tumor-free laparoscopic RS group showed significantly better and more tightly distributed two-year QALY than the open RS group (w\u0026thinsp;=\u0026thinsp;3060, p\u0026thinsp;=\u0026thinsp;0.003). This study provides evidence that when performed by surgeons meeting stringent credentialing criteria, tumor-free laparoscopic surgery (Peritoneal Irrigation; Secure Ligation) achieves comparable oncologic outcomes to open surgery in specific LACC patients.\u003c/p\u003e \u003cp\u003eOur conclusions have several limitations. First, most surgical patients were recruited from a single center, which may introduce selection bias. Treatment selection was based on clinical decision-making, potentially introducing bias that PSM can only partially mitigate by addressing observed confounders. Second, the relatively short follow-up period limited the number of observed events (recurrence or death). Finally, further randomized controlled trials and long-term survival data for specific LACC subtypes (FIGO 2018 stages IB3, IIA2, or IIICr) are warranted to construct and validate a robust survival scoring model.\u003c/p\u003e \u003cp\u003eOur study demonstrates that in specific LACC cases (FIGO 2018 stages IB3, IIA2, or IIICr), RS therapy yields survival outcomes (OS, PFS, and two-year QALYs) comparable to those achieved with definitive CCRT. Furthermore, tumor-free laparoscopic surgery was non-inferior to open surgery in terms of PFS and OS, while also associated with superior two-year QALYs. This multicenter, prospective cohort study advances the understanding of precision therapy for specific LACC (FIGO 2018 stages IB3, IIA2, or IIICr) and provides clinically relevant, real-world evidence from a Chinese population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCCRT, concurrent chemoradiotherapy\u003c/p\u003e \u003cp\u003eLACC, specific locally advanced cervical cancer\u003c/p\u003e \u003cp\u003eOS, overall survival\u003c/p\u003e \u003cp\u003ePFS, progression-free survival\u003c/p\u003e \u003cp\u003eAEs, adverse events\u003c/p\u003e \u003cp\u003eQALYs, quality-adjusted life years\u003c/p\u003e \u003cp\u003ePSM, Propensity score matching\u003c/p\u003e \u003cp\u003eQoL, quality of life\u003c/p\u003e \u003cp\u003eDFS, disease-free survival\u003c/p\u003e \u003cp\u003eRH, radical hysterectomy\u003c/p\u003e \u003cp\u003eBS, bilateral salpingectomy\u003c/p\u003e \u003cp\u003ePLD, pelvic lymphadenectomy\u003c/p\u003e \u003cp\u003ePALD, para-aortic lymphadenectomy\u003c/p\u003e \u003cp\u003eDMFS, Distant metastasis-free survival\u003c/p\u003e \u003cp\u003eHRs, hazard ratios\u003c/p\u003e \u003cp\u003eFDR, false discovery rate\u003c/p\u003e \u003cp\u003eSMDs, standardized mean differences\u003c/p\u003e \u003cp\u003eLNSURH, laparoscopic nerve-sparing ultra-radical hysterectomy\u003c/p\u003e \u003cp\u003eLRH-Karez, Laparoscopic Radical Hysterectomy with Karez technique\u003c/p\u003e \u003cp\u003eARH, Abdominal Radical Hysterectomy\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis protocol has received approval from the Ethics Committees of the Obstetrics and Gynecology Hospital of Fudan University (No. 2021-12), Fudan University Shanghai Cancer Center (No. 2209260-24), and The Sixth Hospital of Shanghai Jiao Tong University School of Medicine (No. 2022-KY-150 (K)). The trial will adhere to Good Clinical Practice (GCP) standards and be conducted following the principles outlined in the World Medical Association\u0026rsquo;s Declaration of Helsinki.\u0026nbsp;Written informed consent were obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was supported by funding from Medical Innovation Research of Shanghai Science and Technology (22Y31900500), and Shanghai Hospital Development Center (SHDC2020CR6009, SHDC2020CR1045B, SHDC22021307 and SHDC2020CR4087); Medical Innovation Research of Shanghai Science and Technology (21Y 11906900), the Eastern Talent Plan Project, the Simulated RCT study of Shanghai Shenkang Hospital Development Center (SHDC2024CRI060), and Huangpu Youth Talent Project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProvenance and peer review\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot commissioned, externally peer-reviewed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQ.L. and J.Q. conceived and designed the study. Q.L., S.S., Y.H., Y.L., and L.J. were responsible for patient sample and data collection. W.L., Q.L., and Y.D. designed the analytical approach, performed data analysis, and interpreted the results. Q.L., W.L., J.Q., X.Q., and Y.Y. drafted the manuscript and critically revised it for important intellectual content. Q.L. and W.L. contributed to figure preparation. J.Q., Y.Y., J.F., and K.H. supervised the study. Q.L. and J.Q. had full access to all study data. All authors have read and approved the final manuscript. Each author agrees to be personally accountable for their contributions and for ensuring that questions regarding the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSung H, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSerkies K, Jassem J. Systemic therapy for cervical carcinoma - current status. Chin J Cancer Res. 2018;30(2):209\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQiu J, et al. 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Int J Gynecol Cancer. 2011;21(1):92\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang J, et al. Comparing survival outcomes between surgical and radiographic lymph node assessment in locally advanced cervical cancer: A propensity score-matched analysis. Gynecol Oncol. 2020;156(2):320\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang JD, Kong WM, Jiang H. \u003cem\u003e[FIGO 2018 staging of cervical cancer and related issues].\u003c/em\u003e Zhonghua Zhong Liu Za Zhi, 2020. 42(2): pp. 94\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamirez PT, et al. Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer. N Engl J Med. 2018;379(20):1895\u0026ndash;904.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMelamed A, et al. Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer. N Engl J Med. 2018;379(20):1905\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang Y, et al. Survival after laparoscopic radical surgery for stage IA-IIB cervical cancer: 1316 consecutive cases from a national laparoscopic training center in China. Int J Clin Oncol. 2023;28(1):175\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLv X, et al. Effect of modified radical laparoscopic hysterectomy versus open radical hysterectomy on short-term clinical outcomes in early-stage cervical cancer: a single-center, prospective, randomized controlled trial. World J Surg Oncol. 2023;21(1):167.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCeccaroni M, et al. Total laparoscopic vs. conventional open abdominal nerve-sparing radical hysterectomy: clinical, surgical, oncological and functional outcomes in 301 patients with cervical cancer. J Gynecol Oncol. 2021;32(1):e10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang W, et al. Laparoscopic vs. Abdominal Radical Hysterectomy for Locally Advanced Cervical Cancer. Front Oncol. 2019;9:1331.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYuan Z, et al. Laparoscopic vs. Open Abdominal Radical Hysterectomy for Cervical Cancer: A Single-Institution, Propensity Score Matching Study in China. Front Oncol. 2019;9:1107.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen C, et al. Comparison of survival outcomes between laparoscopic surgery and abdominal surgery for radical hysterectomy as primary treatment in patients with stage IB2/IIA2 cervical cancer. J Obstet Gynaecol Res. 2021;47(4):1516\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao W, et al. Survival Outcomes in Patients With 2018 FIGO Stage IA2-IIA2 Cervical Cancer Treated With Laparoscopic Versus Open Radical Hysterectomy: A Propensity Score-Weighting Analysis. Front Oncol. 2021;11:682849.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWei WW, et al. Survival Impacts of Perineural Invasion on Patients Under Different Radical Hysterectomies Due to Early Cervical Cancer. Front Oncol. 2022;12:889862.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRiaz A. A., Revised Strengthening the Reporting of Cohort, Cross-Sectional and Case-Control Studies in Surgery (STROCSS) Guideline: An Update for the Age of Artificial Intelligence. Premier J Sci, 2025. 2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat. 2011;10(2):150\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurke TW. Treatment Options in Stage IB Cervical Cancer: Radical Hysterectomy and Radiotherapy. Semin Radiat Oncol. 1994;4(1):34\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhotopulos GJ. Surgery or radiation for early cervical cancer. Clin Obstet Gynecol. 1990;33(4):872\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang W, et al. Long-Term Oncological Outcomes After Laparoscopic Versus Abdominal Radical Hysterectomy in Stage IA2 to IIA2 Cervical Cancer: A Matched Cohort Study. Int J Gynecol Cancer. 2016;26(7):1264\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark JY, et al. Laparoscopic versus open radical hysterectomy in patients with stage IB2 and IIA2 cervical cancer. J Surg Oncol. 2013;108(1):63\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNam JH, et al. Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study. Ann Oncol. 2012;23(4):903\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang X, et al. Laparoscopic radical hysterectomy with Karez technique for stage IB3 and IIA2 cervical cancer: a multicenter retrospective cohort study. Int J Surg. 2025;111(7):4516\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInsinga RP, et al. Cost-effectiveness of pembrolizumab in combination with chemotherapy versus chemotherapy and pembrolizumab monotherapy in the first-line treatment of squamous non-small-cell lung cancer in the US. Curr Med Res Opin. 2019;35(7):1241\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZheng Z, et al. Cost-effectiveness analysis of pembrolizumab plus chemotherapy for patients with recurrent or metastatic cervical cancer in China. Curr Med Res Opin. 2023;39(3):433\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCai H, et al. Atezolizumab plus bevacizumab and chemotherapy versus bevacizumab plus chemotherapy for metastatic cervical cancer: a cost-effectiveness analysis. Front Pharmacol. 2024;15:1476256.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLesnock JL, et al. Upfront treatment of locally advanced cervical cancer with intensity modulated radiation therapy compared to four-field radiation therapy: a cost-effectiveness analysis. Gynecol Oncol. 2013;129(3):574\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Locally advanced cervical cancer (LACC), Radical surgery, Laparoscopy, Hysterectomy, Prognosis, PSM","lastPublishedDoi":"10.21203/rs.3.rs-9161019/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9161019/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWhile concurrent chemoradiotherapy (CCRT) is the standard first-line treatment, radical surgery (RS) is frequently preferred in China, despite unclear comparative efficacy. The role of minimally invasive surgery also remains controversial and requires further validation. These persistent uncertainties underscore the need to advance research into LACC treatment strategies.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e We conducted a multicenter prospective cohort study at three tertiary teaching hospitals in Shanghai, including 246 patients with specific locally advanced cervical cancer (LACC; FIGO 2018 stages IB3, IIA2, or IIICr). We compared overall survival (OS), progression-free survival (PFS), adverse events (AEs), and two-year quality-adjusted life years (QALYs) between RS (n\u0026thinsp;=\u0026thinsp;198) and definitive CCRT (n\u0026thinsp;=\u0026thinsp;48), and further compared tumor-free laparoscopic RS (n\u0026thinsp;=\u0026thinsp;119) with open RS (n\u0026thinsp;=\u0026thinsp;79). Propensity score matching (PSM) was applied to reduce potential confounding. Subgroup analyses were conducted according to key clinical factors, and sensitivity analyses were performed to assess the robustness of the results.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAfter PSM, there were no significant differences in OS or PFS between the RS and the definitive CCRT groups (Two-year OS: 92% [86\u0026ndash;97%] vs. 91% [82\u0026ndash;100%]; Two-year PFS: 79% [72\u0026ndash;87%] vs. 78% [66\u0026ndash;91%]), nor between the tumor-free laparoscopic and the open RS groups (Two-year OS: 97% [93\u0026ndash;100%] vs. 91% [84\u0026ndash;98%]; Two-year PFS: 82% [74\u0026ndash;92%] vs. 78% [69\u0026ndash;89%]). Subgroup and sensitivity analyses yielded consistent findings. Two-year QALYs were comparable between the RS and the definitive CCRT groups (23.55 [22.54, 24.00] vs. 23.53 [22.60, 23.80] months; w\u0026thinsp;=\u0026thinsp;3148, p\u0026thinsp;=\u0026thinsp;0.074), but significantly higher in the tumor-free laparoscopic RS group than in the open RS group (24.00 [23.52, 24.00] vs. 23.52 [21.77, 24.00] months; w\u0026thinsp;=\u0026thinsp;3060, p\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eRS and definitive CCRT provided comparable survival outcomes and two-year QALYs in specific LACC patients (FIGO 2018 stages IB3, IIA2, or IIICr). Within the surgical cohort, tumor-free laparoscopic RS achieved similar survival outcomes as open RS but offered better two-year QoL benefits, supporting its role as a potential surgical option under strict oncologic principles.\u003c/p\u003e","manuscriptTitle":"Comparative Effectiveness of Radical Surgery versus Concurrent Chemoradiotherapy in Stage IB3, IIA2, or IIICr Cervical Cancer: A Prospective, Multicenter, Propensity Score-Matched Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-09 15:03:17","doi":"10.21203/rs.3.rs-9161019/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-07T09:27:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-20T12:24:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"125083804720240918758689932530922117038","date":"2026-04-20T09:34:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-17T05:06:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"272522902470291873771042983327516959223","date":"2026-04-16T23:15:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-02T13:44:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-02T13:30:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-26T18:27:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-26T13:56:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2026-03-26T13:50:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a72da482-2fb6-4977-92e7-9b429e0035f1","owner":[],"postedDate":"April 9th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-07T09:27:15+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T09:40:19+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-09 15:03:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9161019","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9161019","identity":"rs-9161019","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}