Survival outcomes of postoperative radiotherapy and chemotherapy in early-stage cervical cancer: a Surveillance, Epidemiology, and End Results database-based stratified analysis
Background For early-stage cervical cancer, surgery constitutes the standard therapeutic approach. Whether adjuvant radiotherapy and chemotherapy should be administered to patients with intermediate- or high-risk pathological characteristics continues to generate debate. Controversy persists regarding the ideal postoperative adjuvant treatment approach for this patient population. Using the Surveillance, Epidemiology, and End Results (SEER) database, this study compared survival outcomes among early-stage cervical cancer patients managed with observation, postoperative radiotherapy (PORT), or postoperative concurrent chemoradiotherapy (POCRT). Methods Patients with stage I–II cervical cancer who underwent surgical treatment from 2004 to 2020 were identified through the SEER database. Patients were classified into three cohorts based on their postoperative management: observation, PORT, and POCRT. Overall survival (OS) and cancer-specific survival (CSS) were assessed through Cox proportional hazards regression, competing risk modeling, Kaplan-Meier survival curves, and subgroup analyses. Results Among 13,687 eligible patients, 9,868 underwent postoperative observation, 1,237 received PORT, and 2,582 received POCRT. In the unmatched overall cohort, patients receiving adjuvant therapy had higher mortality rates and higher-risk baseline profiles. Stratified analysis demonstrated that postoperative observation was associated with better survival than PORT and POCRT in stage I patients (P<0.001), whereas POCRT was associated with better survival compared with observation and PORT in stage II patients (P=0.04). Subgroup analyses suggested associations between postoperative adjuvant therapy and better survival among patients with T2 disease, N1 status, multiple primary malignancies (≥2), or age ≥60 years. Conclusions For patients with early-stage cervical cancer, the decision regarding PORT and chemotherapy should remain guided by current guideline-based risk stratification. Our findings suggest that tumor (T) stage, node (N) stage, multiple primary malignancies, and age warrant further investigation as potential effect modifiers.