Survival advantage for chemoradiation compared with monotherapy in stage IVB cervical cancer: a propensity score balanced observational investigation

Objectives: Stage IVB cervical cancer is rare representing less than 5% of all cervical cancers. Treatment options include radiation (RT), chemotherapy (CT), surgery in rare cases and/or multimodality combinations. Current evidence suggests that chemoradiation (CRT) may be more effective than CT or RT alone. This study evaluated the impact of the different types of adjuvant treatment on overall survival (OS) in stage IVB cervical cancer after excluding patients who underwent surgery. Methods: Women diagnosed with stage IVB cervical cancer between 2004 and 2014 and treated with RT alone, CT alone or CRT were evaluated. The source of data was the National Cancer Database. Surgical patients and those with multiple malignancies were excluded. Differences in clinical characteristics between the treatment groups were identified and then balanced using a propensity score approach. Survival was evaluated using weighted Kaplan-Meier method. Adjusted hazard ratio (aHR) and 95% confidence interval (CI) for risk of death were estimated in cohorts before and after balancing using weighted multivariate Cox modeling. Results: There were 3,670 eligible participants including 62.1% treated with CRT, 23.6% with CT alone and 14.3% with RT alone. Median follow-up time was 51 months with 2,962 deaths at the time of the analysis. Patients treated by RT were older and had a higher comorbidity score than those treated with CRT or CT (P Download : Download high-res image (231KB) Download : Download full-size image Conclusions: CRT was associated with superior survival compared with CT or RT in this observational, hospital-based cohort after adjustment for prognostic covariates and merits further investigation in a prospective clinical trial. The contents of this abstract are those of the authors and do not reflect the views, opinions or policies of the USUHS, the Henry Jackson Foundation, the Department of Defense, the Departments of the Army, Navy, or Air Force or the U.S. Government.