Real-World Guideline Concordance and Potential Overtreatment Following Primary Radical Hysterectomy for Early-Stage Cervical Cancer

Background/Objectives: International guidelines recommend risk-adapted postoperative management in early-stage cervical cancer; however, the extent to which these recommendations are implemented in routine clinical practice remains incompletely characterized, particularly among patients without high-risk pathological features. This study evaluated real-world concordance with the 2023 European Society of Gynecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology (ESGO/ESTRO/ESP) recommendations and investigated the clinical implications of potential overtreatment. Methods: We retrospectively evaluated a single-center cohort of 135 patients treated with primary radical hysterectomy for early-stage cervical cancer at our institution. Postoperative pathological risk factors were used to stratify patients in accordance with the 2023 ESGO/ESTRO/ESP guidelines. Postoperative management was classified as guideline-concordant or potential overtreatment. Disease-free survival (DFS) and overall survival (OS) were assessed by Kaplan–Meier analysis and univariable Cox proportional hazards regression. Results: The high-risk group comprised 50 patients (37.0%), and the non-high-risk group comprised the remaining 85 patients (63.0%). Among non-high-risk patients, 28 (32.9%) received guideline-concordant postoperative management, whereas 57 (67.1%) received treatment classified as potential overtreatment. The distribution of postoperative treatment intensity differed significantly according to guideline-concordance status (p < 0.001). However, DFS did not differ significantly between the guideline-concordant and potential overtreatment groups (log-rank p = 0.62; hazard ratio [HR] = 1.38, 95% confidence interval [CI] 0.38–5.06), nor did OS (log-rank p = 0.85; HR = 1.09, 95% CI 0.42–2.84). Conclusions: Postoperative management showed substantial variation among patients without high-risk pathological features, with potential overtreatment observed in approximately two-thirds of this cohort. No statistically significant differences in DFS or OS were observed between the groups; however, the limited number of events and wide confidence intervals preclude exclusion of clinically meaningful treatment effects.