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

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. METHOD 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.