Effect of pre‐operative radiotherapy on long‐term outcomes among women with Stage IB1 to IIB cervical squamous cell carcinoma

Abstract

Objective To compare long‐term outcomes between pre‐operative radiotherapy followed by open surgery and direct open surgery among women with Stage IB1–IIB cervical squamous cell carcinoma. Methods A multicenter retrospective cohort study among women with Stage IB1–IIB cervical squamous cell carcinoma who underwent open surgery either directly (SD group) or with pre‐operative radiotherapy (PR group) in China 2004–2016. Five‐year overall survival (OS) and disease‐free survival (DFS) between the two groups were compared by Kaplan–Meier methods and multivariate Cox regression. Results Overall, 8385 women with Stage IB1–IIB were included (PR group, n = 447; SD group, n = 7938). Five‐year OS and DFS was significantly lower in the PR than in the SD group (OS: 81.7% vs 91.6%, P < 0.001; DFS: 76.3% vs 86.7%, P < 0.001). As compared with direct surgery, pre‐operative radiotherapy was an independent risk factor for 5‐year OS (adjusted hazard raio [aHR], 1.75; 95% confidence interval [CI], 1.34–2.30) and DFS (aHR, 1.37; 95% CI, 1.09–1.73) by multivariate Cox regression. Sensitivity analyses confirmed the findings. Conclusion Among women with Stage IB1–IIB cervical squamous cell carcinoma, outcomes were found to be worse for those undergoing pre‐operative radiotherapy followed by open surgery than for those undergoing direct open surgery.