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Propensity Score Analysis of Radical Hysterectomy Versus Definitive Chemoradiation for FIGO Stage IIB Cervical Cancer
  1. Natsuo Tomita, MD, PhD*,
  2. Mika Mizuno, MD, PhD,
  3. Chiyoko Makita, MD, PhD,
  4. Shinji Kondo, MD, PhD,
  5. Masahiko Mori, MD, PhD,
  6. Jun Sakata, MD, PhD,
  7. Hirofumi Tsubouchi, MD,
  8. Kimiko Hirata, MD, PhD§,
  9. Hiroyuki Tachibana, MD* and
  10. Takeshi Kodaira, MD, PhD*
  1. *Departments of Radiation Oncology and
  2. Gynecologic Oncology, Aichi Cancer Center Hospital, Nagoya;
  3. Department of Radiation Oncology, Gifu Prefectural General Medical Center, Gifu; and
  4. §Department of Radiation Oncology, Kyoto City Hospital, Kyoto, Japan.
  1. Address correspondence and reprint requests to Natsuo Tomita, MD, PhD, Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusaku, Nagoya 464-8681, Japan. E-mail: ntomita{at}aichi-cc.jp.

Abstract

Objective The aim of this study was to compare the outcomes and toxicities of radical hysterectomy (RH) and definitive chemoradiation (CRT) for International Federation of Gynecology and Obstetrics (FIGO) stage IIB cervical cancer.

Materials and Methods A retrospective analysis was performed on FIGO stage IIB patients who underwent RH with adjuvant radiotherapy (surgery group) or intended to receive CRT (CRT group). The distributions of disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Propensity score matching (PSM) was performed for the 2 groups based on age, tumor diameter, histological type, and pelvic node metastasis in pretreatment imaging tests.

Results Median follow-up times were 58 months in the surgery group (n = 75) and 55 months in the CRT group (n = 65). Propensity score matching identified 37 patients with similar characteristics from each group. Significant differences were observed in the ratio of the chemotherapy combination between the surgery and CRT groups before (47% vs 98%) and after PSM (51% vs 100%). Five-year DFS rates were slightly higher in the surgery group than in the CRT group before PSM (69% vs 58%, P = 0.30) but were similar after PSM (76% vs 82%, P = 0.36). Five-year OS rates were similar between the surgery and CRT groups before (70% vs 75%, P = 0.59) and after PSM (78% vs 77%, P = 0.97). The results of multivariate analyses also showed that neither DFS nor OS was associated with the treatment modalities regardless of PSM. The incidence of late toxicities grade 2 or greater was similar between the surgery and CRT groups before (17% vs 23%, P = 0.31) and after PSM (19% vs 24%, P = 0.78).

Conclusions The results of this study suggest that RH with adjuvant radiotherapy and definitive CRT are equivalent treatment options for patients with FIGO stage IIB cancer. However, prospective larger studies are needed to confirm this.

  • Hysterectomy
  • Propensity score matching
  • Radiotherapy
  • Uterine cervical cancer

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Footnotes

  • The authors declare no conflicts of interest.

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