Comparison of postoperative adjuvant therapy for early-stage cervical cancer: A surveillance, epidemiology, and end results analysis.

Objectives: To compare the effects of different adjuvant treatments for different pathological types of early-stage cervical cancer post-surgery.

Materials and methods: Patients with International Federation of Gynecology and Obstetrics (FIGO) stages I-II squamous cell carcinoma (SCC), adenocarcinoma (ADC), and adenosquamous carcinoma (ASC) who underwent hysterectomy and postoperative radiotherapy (RT) from 2004 to 2015 in the surveillance, epidemiology, and end results program database were analyzed. The clinicopathological characteristics and survival rates were compared.

Results: A total of 5444 cases were included. ADC had the highest 5-year overall survival (OS) and cervical carcinoma-specific survival (CCSS) rates, followed by SCC and ASC. No significant difference in prognosis was noted among the three histological subtypes when treated with chemoradiation therapy (CRT). However, the survival benefit for ASC was significantly lower than that for SCC (hazard ratio [HR], 1.625; 95% confidence interval [CI], 1.024-2.579; P = 0.039) when treated with RT alone. The prognosis of FIGO stage I patients was significantly better with RT than with CRT (HR, 0.766; 95% CI, 0.622-0.943; P = 0.012). No significant differences in CCSS were observed between patients (stages I and II) treated with external beam RT (EBRT) and EBRT + intracavity brachytherapy.

Conclusion: No significant differences in OS and CCSS were observed among the three histological subtypes. The prognosis of ASC patients who received CRT was better than that of those who received RT alone. Patients with stage I tumors could obtain better survival with RT alone. The addition of brachytherapy to EBRT yielded no benefits across the three histological subtypes.