Prognosis of bulky pT2b cervical cancer treated by radical hysterectomy comparing adenocarcinoma with squamous cell carcinoma using propensity score matching.

Objective To investigate whether radical hysterectomy (RAH) can effectively treat true stage IIB (pT2b) cervical adenocarcinoma (AC) because FIGO (clinical) stage IIB cervical cancer is rarely treated with RAH and radiotherapy has unfavorable effects on AC. Methods We retrospectively analyzed data for 82 patients with stage pT2b cervical cancer who underwent RAH at our institution between January 1997 and December 2017. The endpoints were disease-free survival (DFS) and overall survival (OS) among squamous cell carcinoma (SCC) (n=60) and AC (n=22) patients. Kaplan-Meier survival analysis with and without propensity score matching was conducted to identify the impact of RAH. Results Paraaortic lymph node metastasis and tumor diameter were significant factors for recurrence, and adjuvant chemotherapy prevented recurrence on multivariate analysis. After propensity score matching, there was no significant difference in DFS and OS between the groups. Five-year DFS and OS of the SCC group were 0.505 (95% CI 0.268-0.702) and 0.619 (95% CI 0.351-0.803), respectively, and those of the AC group were 0.444 (95% CI 0.232-0.638) and 0.602 (95% CI 0.351-0.782), respectively. Conclusion Bulky stage pT2b cervical cancer is hard to cure, but RAH plus adjuvant therapy might be an option for radio-resistant pT2b cervical AC.