Definitive chemoradiotherapy versus radical hysterectomy followed by tailored adjuvant therapy in women with early-stage cervical cancer presenting with pelvic lymph node metastasis on pretreatment evaluation: A propensity score matching analysis

Abstract Objective To compare the oncologic outcomes between chemoradiotherapy and radical hysterectomy followed by tailored adjuvant therapy in patients with early cervical cancer presenting with pelvic lymph node metastasis. Methods We retrospectively analyzed the medical records of women with early cervical cancer presenting with positive pelvic nodes identified on pretreatment imaging assessment. Propensity score matching was employed to control for the heterogeneity between two groups according to confounding factors. Overall survival, disease-free survival, and pattern of failure were compared between the two groups in all patients as well as the matched cohort. Results A total 262 patients were identified; among them, 67 received definitive chemoradiotherapy (group A) and 195 received hysterectomy (group B). Adjuvant therapy was administered to 88.7% of group B. There were no significant differences between group A and group B regarding the 5-year overall survival rates (89.2% vs. 89.0%) as well as disease-free survival rates (80.6% vs. 82.7) in the entire cohort, and patterns of failure. Distant metastasis was the major failure pattern identified in groups A and B (16.4% and 15.4%). In multivariate analysis, non-squamous histology was significantly associated with poorer overall survival. Conclusion There were no significant differences in oncologic outcomes between definitive chemoradiotherapy and radical hysterectomy followed by tailored adjuvant therapy for early stage cervical cancer patients who had pelvic lymph node metastasis on pretreatment imaging assessment. Definitive chemoradiotherapy could avoid the complication of combined modality therapy without compromising oncologic outcomes.