Radiation- versus surgery-based treatment for patients with resectable IIIC1 cervical adenocarcinoma

To describe the utilization trend of radiation-based and surgery-based treatment in patients with resectable IIIC1 cervical adenocarcinoma and explore the optimal treatment strategy for these patients.

Patients with resectable IIIC1 cervical adenocarcinoma in 2005-2022 from Surveillance, Epidemiology, and End Results program (SEER) were analyzed. Trends over time in the utilization of radiation- and surgery-based treatment were plotted and estimated using Mantel-Haenszel test. Logistic regression analysis was performed to identify factors associated with the utilization of treatment. Survival outcomes were assessed and compared using Kaplan-Meire method and log-rank test, respectively. Inverse probability of treatment weighting (IPTW) was performed for adjustment of baseline characteristics. Sensitivity analysis was conducted using a cohort of cervical adenocarcinoma patients from our institution.

The utilization of radiation-based treatment has grown steadily from 2005 to 2022 while the trend for surgery-based treatment showed opposite way (P = 0.002). Age, year of diagnosed, tumor size and T stage impacted the utilization of radiation-based treatment (All P < 0.05). Surgery-based treatment demonstrated superior overall survival (HR = 0.55, 95%CI:0.44-0.69; P < 0.001) and cancer specific survival (HR = 0.58, 95%CI:0.45-0.75; P < 0.001) to radiation-based treatment before adjustment of IPTW. However, no significant differences were observed in overall survival (HR = 0.77, 95%CI:0.56-1.05; P = 0.1) and cancer specific survival (HR = 0.86, 95%CI:0.60-1.23; P = 0.4) after baseline characteristics were balanced. Besides, the cohort from our institution further verified that similar survival outcomes were observed between two treatment strategies.

The utilization of radiation-based treatment has increased over time and showed non-inferior efficacy for patients with resectable IIIC1 cervical adenocarcinoma when compared to surgery-based treatment.