Survival Benefit of Surgical Staging Before Radiotherapy in Locally Advanced Cervical Cancer: A Pooled Analysis

Lymph node metastasis significantly impacts prognosis and treatment in locally advanced cervical cancer (LACC). Surgical staging offers precise information on node involvement, though its survival benefit is debated. We pooled data from 9 cohort studies involving 2553 patients to evaluate the benefit of pre-treatment surgical staging in patients with locally advanced cervical cancer. Fixed effects models or random effects models were used to calculate the pooled hazard ratios (HRs). The overall pooled results showed no difference in PFS (HR 0.94, 95% CI 0.73-1.22, p = 0.65) or OS (HR 1.00, 95% CI 0.74-1.35, p = 0.99) between the two approaches of lymph node staging. However, the subgroup analyses found the PFS superiority of surgical staging in patients with FIGO stage II (HR 0.68, 95% CI 0.49-0.95, p = 0.02). Additionally, for the patients with no evidence of lymph node metastasis on imaging, surgical staging was associated with significantly improved PFS (HR 0.69, 95% CI 0.56-0.86, p = 0.001) and OS (HR 0.56, 95% CI 0.36-0.87, p = 0.01). In the subgroup of patients with suspicious bulky nodes on imaging, lymph node debulking-based surgical staging did not significantly improve either PFS (HR 0.97, 95% CI 0.72-1.31, p = 0.31) or OS (HR 1.16, 95% CI 0.68-1.99, p = 0.59) in comparison with imaging staging. Surgical staging may not be applicable to all patients with LACC. However, for the patients with FIGO II disease or those without suspicious lymph node involvement on imaging, node surgery staging could afford a survival benefit. Trial Registration: PROSPERO ID: CRD42024543768.