Comparison of Survival After Radical Hysterectomy or Radical Radiotherapy Among Patients with Different Histological Types of Locally Advanced Cervical Cancer: Analysis of SEER Data Using Propensity Score Matching

Objective: To compare survival of patients with different histological types of locally advanced cervical cancer after treatment with radical surgery or radical radiotherapy. Methods: Data for United States residents diagnosed with locally advanced cervical cancer between 2000 and 2022 were extracted from the Surveillance, Epidemiology, and End Results database. Overall survival and cancer-specific survival were compared using multivariable Cox proportional hazards regression. To minimize baseline differences, patients from each group were paired using propensity score matching. Results: Among the 1,363 patients with squamous cell carcinoma in the propensity score-matched cohort, surgery was associated with significantly better overall survival when disease was in stage IB3 (HR 0.70, 95% CI 0.50–0.97), but not when it was in other stages. Cancer-specific survival did not differ significantly between the two treatments at any disease stage. Among the 576 patients with adenocarcinoma in the propensity-score-matched cohort, surgery was associated with significantly better overall survival in stages IB3 (HR 0.46, 95% CI 0.28–0.77) or IIA2 (HR 0.38, 95% CI 0.15–0.96) or IIB involving tumors < 4 cm (HR 0.36, 95% CI 0.16–0.80). It was also associated with significantly better cancer-specific survival in stages IB3 (HR 0.51, 95% CI 0.29–0.90), IIA2 (HR 0.22, 95% CI 0.07–0.76) or IIB involving tumors < 4 cm (HR 0.21, 95% CI 0.07–0.62). Conclusions: Surgery may be associated with better overall survival than radiotherapy in stage IB3 squamous cell carcinoma. In the case of adenocarcinoma, surgery may be associated with better overall and cancer-specific survival than radiotherapy in stage IB3 or IIA2 and in stage IIB involving tumors < 4 cm.