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Rising Rates of Upfront Surgery in Early Locally Advanced Cervical Cancer: What Factors Predict for This Treatment Paradigm?
  1. Arya Amini, MD*,,
  2. Tyler P. Robin, MD, PhD,
  3. Priscilla K. Stumpf, MD,
  4. Chad Rusthoven, MD,
  5. Tracey E. Schefter, MD,
  6. Ashwin Shinde, MD*,
  7. Yi-Jen Chen, MD, PhD*,
  8. Scott M. Glaser, MD*,
  9. Bradley R. Corr, MD and
  10. Christine M. Fisher, MD, MPH
  1. *Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, CA; Departments of
  2. Radiation Oncology, and
  3. Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO.
  1. Address correspondence and reprint requests to Arya Amini, MD, Department of Radiation Oncology, City of Hope National Cancer Center, 1500 E Duarte Rd, Duarte, CA 91010. E-mail: aamini{at}


Objective In this study, we analyzed patterns of care for patients with locally advanced cervical cancer to identify predictors for upfront surgery compared with definitive chemoradiation (CRT).

Methods The National Cancer Database was queried for patients aged 18 years or older with Federation of Gynecology and Obstetrics IB2–IIB cervical cancer. All patients underwent either upfront hysterectomy with or without postoperative radiation therapy versus definitive CRT. Logistic regression was used to assess variables associated with modality of treatment (surgery vs CRT).

Results Of the 9494 patients included, 2151 (22.7%) underwent upfront surgery. Of those undergoing surgery, 380 (17.7%) had positive margins, 478 (22.2%) had positive nodes, and 458 (21.3%) had pathologic involvement of the parametrium. Under multiple logistic regression, rates of surgery significantly increased from 2004 (12.2%) to 2012 (31.2%) (odds ratio [OR] per year increase, 1.15; confidence interval [CI], 1.12–1.17; P < 0.001). Upfront surgery was more commonly performed in urban (OR, 1.21; 95% CI, 1.03–1.41; P = 0.018) and rural counties (OR, 1.79; 95% CI, 1.24–2.58; P = 0.002), for adenocarcinoma (OR, 2.14; 1.88–2.44; P < 0.001) and adenosquamous (OR, 2.69; 2.11–3.43; P < 0.001) histologies, and in patients from higher median income communities (ORs, 1.19–1.37). Upfront surgery was less common at academic centers (OR, 0.73; 95% CI, 0.58–0.93; P = 0.011).

Conclusions Rates of upfront surgery relative to definitive CRT have increased significantly over the past decade. In the setting of level 1 evidence supporting the use of definitive CRT alone for these women, the rising rates of upfront surgery raises concern for both unnecessary surgical procedures with higher rates of treatment-related morbidity and greater health care costs.

  • Cervical cancer
  • Surgery
  • Hysterectomy
  • Postoperative radiation therapy
  • Chemoradiation
  • National Cancer Database

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  • The authors declare no conflicts of interest.

  • All authors have read and approved the manuscript. This manuscript is not under consideration elsewhere.