Article Text
Abstract
Introduction To assess survival differences between non-extensive surgery (NES) and extensive surgery (ES) in initially diagnosed FIGO stage IVB cervical cancer patients receiving chemotherapy from a population-based database, the Surveillance, Epidemiology and End Results (SEER).
Methods FIGO stage IVB Cervical cancer patients receiving chemotherapy who underwent surgery between 2010-2019 were included. Propensity matching was conducted to minimize heterogeneity. The impact of survival was determined blog-rank test and Cox proportional hazards model.
Results 84 patients underwent NES while 70 underwent ES. After matching, patients receiving chemotherapy who underwent NES presented with a median overall survival (OS) of 51.5 months while patients who underwent ES had a median OS of 31 months. In all patients, no survival advantage was observed in ES group in contrast with NES group (P=0.066, hazard ratio [HR]=1.54, 95% confidence interval [CI]=10.97-2.42). Stratified analyses suggested extensive surgery associated with improved overall survival in patients with histology other than squamous cell carcinoma and adenocarcinoma (P=0.028, HR=0.36, 95%CI=0.15-0.89), AJCC T stage T1 (P=0.009, HR=0.18, 95%CI=0.05-0.66). Despite no survival benefit after remove of regional lymph node surgery (P=0.629, HR=0.88, 95%CI=0.53-1.47) in all patients, subgroup analyses demonstrated that patients younger than 50 (P=0.006, HR=0.21, 95% CI= 0.07-0.64), AJCC T stage T1 (P=0.002, HR=0.09, 95% CI=0.02-0.42), AJCC T stage T3 (P=0.001, HR=0.02, 95% CI=0.00-0.21) and hematogenous metastasis (P=0.036, HR=0.27, 95% CI=0.08-0.92) might achieve longer survival.
Conclusion/Implications In conclusion, ES or regional lymph node surgery may provide survival advantage for certain subgroup of FIGO IVB cervical cancer patients receiving chemotherapy. However, it deserves large scale prospective clinical trials to confirm.