Adjuvant Chemotherapy versus Concurrent Chemoradiotherapy for Surgically Treated T1b Uterine Cervical Cancer: A Propensity Score Matched Analysis of the JSOG Nationwide Data

Objective: The aim of this study was to assess the effect of postoperative chemotherapy on the survival of surgically treated patients with T1b uterine cervical cancer.

Methods: Overall, 1687 patients with T1b cervical cancer who received concurrent chemoradiotherapy (CCRT) or chemotherapy as postoperative adjuvant therapy were retrospectively analyzed using the Japan Society of Obstetrics and Gynecology cancer registry program data from 2015 to 2016. After propensity score matching, overall survival (OS) was compared between 643 patients treated with CCRT and 643 patients treated with chemotherapy.

Results: OS was significantly higher in the chemotherapy group than in the CCRT group (hazard ratio [HR] 0.653, 95% confidence interval [CI] 0.448 - 0.953; p = 0.026). In the subgroup analysis, patients with squamous histology and large tumor size (>4 cm) and without lymph node metastasis can benefit from chemotherapy in terms of OS (HR 0.53, 95% CI 0.29-0.95; HR 0.49, 95% CI 0.25-0.95; and HR 0.54, 95% CI 0.33-0.88, respectively).

Conclusion: Patients with cervical cancer with squamous histology, large tumor size and negative lymph node metastasis can benefit from postoperative chemotherapy in terms of survival. Tumor characteristics could be associated with the effect of postoperative adjuvant chemotherapy on survival.