Impact of treatment modality on survival in FIGO stage IIB cervical cancer: a population-based propensity-score matched analysis

To investigate the impact of treatment modality on survival of International Federation of Gynecology and Obstetrics (FIGO) stage IIB cervical cancer. Patients with FIGO stage IIB cervical cancer registered in the Surveillance, Epidemiology, and End Results database between 1988 and 2015 were identified and grouped according to their treatment modalities. Propensity score matching (PSM) was performed to adjust the baseline characteristics. A total of 4718 stage IIB patients with eligible data were identified. Of them, 902 underwent surgery and 3816 received chemoradiotherapy alone. After PSM, 1208 patients were paired without baseline difference. Patients undergoing surgery (n = 604) had significantly improved overall survival (OS, 5-year rate: 68.0%, P = 0.007) and cancer-specific survival (CSS, 5-year rate: 70.4%, P = 0.007) compared with those receiving chemoradiotherapy alone (5-year rates: 59.9% for OS, 62.9% for CSS, n = 604). On multivariate analysis, treatment modality was an independent factor for both OS (hazard ratio [HR] = 1.334, P = 0.002) and CSS (HR = 1.369, P = 0.002). In subgroup analyses, surgery provided significantly better survival than chemoradiotherapy in subgroups with ≤ 4 cm squamous-cell carcinoma (P = 0.046 for OS, P = 0.020 for CSS, n = 143) and > 4 cm non-squamous-cell carcinoma (P = 0.010 for OS, P = 0.004 for CSS, n = 240). However, these differences were not observed in subgroups with > 4 cm squamous-cell carcinoma (P = 0.665 for OS, P = 0.816 for CSS, n = 523) or ≤ 4 cm non-squamous-cell carcinoma (P = 0.173 for OS, P = 0.293 for CSS, n = 30). In this population-based analysis, a surgery-based strategy was associated with improved survival compared to chemoradiation in patients with FIGO stage IIB cervical cancer. Exploratory subgroup analyses suggested that this benefit may vary by histology and tumor size.