A comparative study on oncological outcomes between radical chemoradiotherapy and primary laparotomic open surgery for cervical adenosquamous carcinoma
Objective To investigate the oncological outcomes of radical chemoradiotherapy versus abdominal hysterectomy in patients with adenosquamous carcinoma of the cervix.Methods Patients with adenosquamous carcinoma of the cervix were selected from the Chinese cervical cancer clinical treatment programs.The 2018 FIGO staging classification was uesd as the stratification basis to compare the oncological outcomes of patients undergoing radical chemoradiotherapy and those undergoing abdominal hysterectomy.Results(1)Initial cohort:The radical chemoradiotherapy group consisted of 97 cases,while the abdominal hysterectomy group included 373 cases.The 5-year overall survival(OS)and disease-free survival(DFS)rates in the radical chemoradiotherapy group were both inferior to those in the abdominal hysterectomy group(OS:69.2％vs.83.7％,P＜0.001;DFS:57.8％vs.81.3％,P＜0.001).Cox multivariate analysis indicated that radical chemoradiotherapy was an independent risk factor affecting patient prognosis(OS:HR=2.094,95％CI 1.243～3.530,P=0.006;DFS:HR=2.477,95％CI 1.585～3.871,P＜0.001).(2)For FIGO stage Ⅱ B and earlier:36 patients in the chemoradiotherapy group and 248 in the abdominal hysterectomy group.There was no statistical difference in 5-year OS and DFS between the two groups(OS:89.9％vs.88.3％,P=0.813;DFS:83.6％vs.86.7％,P=0.510).Cox multivariate analysis suggested no statistical difference in prognosis between the two groups(OS:HR=0.731,95％CI 0.152～3.520,P=0.696;DFS:HR=0.726,95％CI 0.218～2.417,P=0.601).(3)For FIGO stage ⅢC:20 patients in the chemoradiotherapy group and 100 in the abdominal hysterectomy group.Both 5-year OS and DFS indicated that the abdominal hysterectomy group had better oncological outcomes(OS:44.6％vs.65.9％,P=0.007;DFS:39.7％vs.61.5％,P=0.012).Cox multivariate analysis suggested no statistical difference in prognosis between the two groups(OS:HR=2.091,95％CI 0.936～4.672,P=0.072;DFS:HR=1.748,95％CI 0.827～3.692,P=0.143).(4)For FIGO stage Ⅲ-Ⅳ:48 patients in the chemoradiotherapy group and 102 in the abdominal hysterectomy group.There was no significant difference in 5-year OS,but the abdominal hysterectomy group had a better 5-year DFS(OS:58.7％vs.66.9％,P=0.160;DFS:38.9％vs.62.4％,P=0.012).Cox multivariate analysis indicated no difference in prognosis between the two groups(OS:HR=2.126,95％CI 0.998～4.537,P=0.051;DFS:HR=1.855,95％CI 0.914～3.766,P=0.087).Conclusions Overall,the oncological outcomes for patients with adenosquamous carcinoma of the cervix were worse in the radical chemoradiotherapy group compared to the abdominal hysterectomy group.However,further stratified analysis using Cox multivariate analysis showed no significant difference in the 5-year oncological outcomes between the two treatment modalities,regardless of whether patients were within stage Ⅱ B or above stage Ⅱ B.
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