Comprehensive Comparison of Surgery Followed by Radiotherapy and Radical Radiotherapy for Cervical Cancer: A Multicenter Retrospective Propensity-Score-Matched Analysis

<b>Background:</b> While surgery and radiotherapy are the standard of care for patients with cervical cancer (CC), debate persists regarding the choice of whether treatment should consist of surgery followed by radiotherapy or initial direct radical radiotherapy. The present study was therefore devised to compare real-world clinical outcomes and economic assessments associated with these different treatment approaches. <b>Methods:</b> Six tertiary medical centers retrospectively identified patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage I-IVA CC who underwent surgery followed by radiotherapy (surgery-radiotherapy group) or radical radiotherapy (radiotherapy group) between 2015 and 2023 in China. The progression-free and overall survival (PFS and OS) of these patients were compared using Kaplan-Meier and propensity-score-weighted proportional risk models. Economic analyses were also conducted based on patient follow-up for up to 8 years from the start of treatment. <b>Results:</b> A total of 980 patients receiving surgery-radiotherapy and radiotherapy were identified for matching. Propensity score weighting revealed no significant statistical differences in PFS (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.44-1.28; <i>p</i> = 0.29) and OS (HR, 0.49; 95% CI, 0.20-1.21; <i>p</i> = 0.12) when comparing these groups. Subgroup analysis found differences in PFS (HR, 0.17; 95% CI, 0.04-0.77; <i>p</i> = 0.02) among adenocarcinoma. Economic analyses revealed that the incremental cost-effectiveness ratio of the surgery-radiotherapy group versus the radiotherapy group was $40,831/quality-adjusted life-year (QALY), which is higher than the Chinese willingness-to-pay threshold of $35,841/QALY. <b>Conclusions:</b> Survival outcomes were similar for patients with CC who underwent surgery-radiotherapy and radiotherapy. Further, radical radiotherapy may be cost-effective for such patients considering economic factors in China.