Comparative effectiveness of radical surgery versus concurrent chemoradiotherapy in stages IB3, IIA2, or locally resectable IIICr cervical cancer: a prospective, multicenter, propensity score-matched cohort study.

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 locally resectable IIICr). We compared overall survival (OS), progression-free survival (PFS), adverse events (AEs), two-year quality-adjusted life years (QALYs), and treatment costs between RS (n = 198) and definitive CCRT (n = 48). We also compared tumor-free laparoscopic RS (n = 119) with open RS (n = 79) within the RS cohort. Propensity score matching (PSM) was applied to reduce potential confounding. Subgroup 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 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 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 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). The median total treatment cost was significantly higher in the RS group than in the definitive CCRT group (96,879 [91,400-104,815] CNY vs. 83,555 [73,790-95,554] CNY; W = 347.000, p = 0.018).

CONCLUSIONS

RS and definitive CCRT provided comparable short-term survival outcomes and two-year QALYs in specific LACC patients, although the RS group tended to be associated with higher treatment costs. Within the surgical cohort, tumor-free laparoscopic RS achieved similar survival outcomes to open RS but offered better two-year QoL benefits, supporting its role as a potential surgical option under strict oncologic principles.