OBJECTIVE: The "intermediate-risk" (IR) group of early-stage cervical cancer patients is characterized by negative pelvic lymph nodes and a combination of tumor-related prognostic risk factors such as tumor size ≥2 cm, lymphovascular space invasion (LVSI), and deep stromal invasion. However, the role of adjuvant treatment in these patients remains controversial. We investigated whether adjuvant (chemo)radiation is associated with a survival benefit after radical surgery in patients with IR cervical cancer. METHODS: We analyzed data from patients with IR cervical cancer (tumor size 2-4 cm plus LVSI OR tumor size >4 cm; N0; no parametrial invasion; clear surgical margins) who underwent primary curative-intent surgery between 2007 and 2016 and were retrospectively registered in the international multicenter Surveillance in Cervical CANcer (SCCAN) study. RESULTS: Of 692 analyzed patients, 274 (39.6%) received no adjuvant treatment (AT-) and 418 (60.4%) received radiotherapy or chemoradiotherapy (AT+). The 5-year disease-free survival (83.2% and 80.3%; PDFS = 0.365) and overall survival (88.7% and 89.0%; POS = 0.281) were not significantly different between the AT- and AT+ groups, respectively. Adjuvant (chemo)radiotherapy was not associated with a survival benefit after adjusting for confounding factors by case-control propensity score matching or in subgroup analyses of patients with tumor size ≥4 cm and <4 cm. In univariable analysis, adjuvant (chemo)radiotherapy was not identified as a prognostic factor in any of the subgroups (full cohort: PDFS = 0.365; POS = 0.282). CONCLUSION: Among patients with IR early-stage cervical cancer, radical surgery alone achieved equal disease-free and overall survival rates to those achieved by combining radical surgery with adjuvant (chemo)radiotherapy.

Amsterdam University Medical Centers Center for Gynaecologic Oncology Amsterdam Amsterdam the Netherlands

Baskent University School of Medicine Department of Gynecology and Obstetrics Division of Gynecologic Oncology Ankara Turkey

Department of Gynaecology and Obstetrics University Hospital Pilsen Charles University Pilsen Czech Republic

Department of Gynecologic Oncology Hospital Italiano de Buenos Aires CABA Buenos Aires Argentina

Department of Gynecologic Oncology Instituto Nacional de Cancerología Bogotá Colombia

Department of Gynecologic Oncology Zekai Tahir Burak Women's Health and Research Hospital University of Health Sciences Ankara Turkey

Department of Gynecological Oncology Barretos Cancer Hospital Barretos São Paulo Brazil

Department of Gynecological Surgery National Institute of Neoplastic Diseases Lima Peru

Department of Obstetrics and Gynecology Faculty of Medicine University Hospital and University of Ostrava Ostrava Czech Republic

Department of Pelvic Cancer Karolinska University Hospital and Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden

Fondazione Policlinico Universitario A Gemelli IRCCS UOC Ginecologia Oncologica Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica Rome Italy

Gynaecologic Surgical Unit ASST Monza San Gerardo Hospital University of Milano Bicocca Monza Italy

Gynecologic Oncology Center Department of Obstetrics and Gynecology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Gynecologic Oncology Unit La Paz University Hospital IdiPAZ Madrid Spain

Gynecology Medical University of Graz Graz Austria

Gynecology Oncology Center National Institute of Cancerology Mexico Mexico

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic

Memorial Sloan Kettering Cancer Center USA

Queensland Centre for Gynaecological Cancer; The University of Queensland Australia

University Hospital Brno Medical Faculty of Masaryk University Brno Czech Republic

Gynecol Oncol. 2023 Aug;175:191. doi: 10.1016/j.ygyno.2023.03.022. PubMed

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