Introduction In 2009 International Federation of Gynecology and Obstetrics (FIGO) staging, patients with stage IB or IIA with lymph node metastasis (LNM) underwent operation or concurrent chemoradiation (CCRT). However, in revised 2018 FIGO staging, patients with LNM were stage IIIC and have been underwent CCRT. The purpose of study was to compare outcome of CCRT and operation in patients with stage IIIC.

Methods Total 106 patients treated either surgical treatment or CCRT for cervical cancer with pelvic and/or paraaortic lymph node metastasis were enrolled retrospectively in study. LNM was confirmed by either radiologically (IIICr) or pathologically (IIICp). We observed 55 patients underwent radical hysterectomy (type 3) between Jan 2011 and Dec 2019 and 51 patients with CCRT between Jan 2001 and Sep 2016.

Results Pathological type was statistically different (p=0.006). Operation group had more prevalence of adenocarcinoma than CCRT group (34.5% vs 7.8%). Kaplan-Meier survival curve showed both overall survival (OS, p=0.424) and disease-free survival (DFS, p=0.183) were not different in two group. However, operation group with LNM confirmed by both radiologically and pathologically (IIICr+p) had worse DFS than CCRT group. Complication rate (54.5% vs 19.6%, p<0.001) and major complication (43.3% vs 20%, p=0.001) were significantly greater in operation group. There was significant difference in recurrence pattern (p=0.026). Operation group had less pelvic/paraaortic LN metastasis, however had more distant and pelvic side wall metastasis.

Conclusion/Implications OS and DFS were not different in two groups. However, operation group with staging IIICr+p had worse DFS than CCRT group. Complication rate and grade were greater in operation group.