The primary surgery improved the survival of FIGO stage IIIC1 cervical cancer with T1b-T2a tumors.

Introduction: Concurrent chemoradiation is the preferred treatment recommendation for stage IIIC1 cervical cancer. Radical surgery is the alternative treatment for this population without parametrial invasion. Approximately 85% of newly diagnosed cases occur in developing countries where brachytherapy facilities and expertise are lacking. This study aimed to compare the efficacy of different primary treatment modality (surgery vs. radiation) in this population.

Methods: This is a retrospective cohort study that included patients registered in the Surveillance, Epidemiology, and End Results program from January 1, 2004 to December 31, 2022. Patients who were diagnosed with stage IIIC1 cervical cancer without parametrial invasion were identified and further stratified into two groups based on the primary treatment modality (surgery or radiation). One-to-one propensity score matching was performed to balance the bias of baseline characteristics between the two groups. The primary outcomes are overall survival (OS) and cause-specific survival (CSS).

Results: Of 2176 patients included, 1690 patients underwent primary surgery (group A) and 486 patients underwent primary radiation (group B). Compared to group B, patients who received surgery as primary treatment had a lower ratio of squamous carcinoma and larger tumor size. After one-to-one matching, no differences were found between the two groups on baseline variables. Compared to group B, patients who received surgery as primary treatment were associated with an increased 5-year OS (73.97% vs. 67.55%, HR 0.749[95% CI: 0.594-0.945], p = 0.0147) and CSS (79.20% vs. 69.96%, HR 0.668[95% CI: 0.516-0.866], p = 0.0023).

Conclusion: Primary surgery may be a more favorable selection for patients with stage IIIC1 cervical cancer without parametrial invasion for improved survival benefits.