Multimodal treatment including hysterectomy improves survival in patients with locally advanced cervical cancer: A population-based, propensity score-matched analysis

Int J Surg. 2017 Dec:48:122-127. doi: 10.1016/j.ijsu.2017.10.028. Epub 2017 Oct 12.

Abstract

Background: To evaluate the therapeutic value of multimodal treatment including hysterectomy in locally advanced cervical squamous cell carcinoma (SCC).

Methods: We retrospectively reviewed patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IIB-III cervical SCC and received chemotherapy and radiotherapy with or without hysterectomy between 2000 and 2013 using the Surveillance, Epidemiology, and End Results program. Propensity score-matching was used to balance baseline characteristics of included patients. Univariate and multivariate Cox regression analyses were performed to determine prognostic factors for cervical cancer specific-survival (CCSS) and overall survival (OS).

Results: We identified 2473 patients and 522 pairs of patients were completely matched with each other. In the unmatched population, patients with younger age, non-black race, poorly/undifferentiated disease, FIGO stage IIB disease, and node-positive disease were more likely to receive additional hysterectomy. Additional hysterectomy was associated with better CCSS and OS in unmatched and matched populations. Moreover, when evaluating the survival difference by FIGO stage, only stage IIB disease retained statistical significance but not for stage III disease in unmatched and matched populations.

Conclusions: Our results suggest that multimodal treatment including hysterectomy might improve survival outcomes in patients with locally advanced cervical SCC, especially for stage IIB disease.

Keywords: Cervical cancer; Chemoradiotherapy; Hysterectomy; Locally advanced; Squamous cell carcinoma.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / therapy*
  • Chemoradiotherapy / methods
  • Chemoradiotherapy / mortality*
  • Combined Modality Therapy
  • Female
  • Humans
  • Hysterectomy / methods
  • Hysterectomy / mortality*
  • Middle Aged
  • Neoplasm Staging
  • Propensity Score
  • Proportional Hazards Models
  • Regression Analysis
  • Retrospective Studies
  • SEER Program
  • Survival Rate
  • Treatment Outcome
  • Uterine Cervical Neoplasms / mortality
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / therapy*
  • Young Adult