Analysis Of The Value Of Postoperative Adjuvant Therapy In Patients With Early Stage And Intermediate Risk Cervical Cancer Who Did Not Meet Sedlis Criteria

BackgroundCervical cancer is the most common malignant tumor of the female reproductive system and its prognosis is good with a 5-year survival rate of about 75%-90%.The primary treatment of cervical cancer is radical hysterectomy with pelvic lymph node dissection.According to NCCN guidelines,patients with cervical cancer who have high-risk factors for recurrence(positive pelvic nodes,positive parametrium,and/or positive surgical margin)need postoperative adjuvant chemoradiotherapy,postoperative adjuvant radiotherapy can prolong survival in patients with early-stage cervical cancer who have intermediate risk factors(lymphovascular space invasion,deep stromal invasion,and larger tumor size)and meet Sedlis criteria.However,there is still some controversy about whether adjuvant therapy is needed after surgery with intermediate risk factors but not meeting the Sedlis criteria,and further prospective studies are needed to confirm.ObjectiveThrough retrospective analysis of the case information of 250 patients with cervical cancer,the clinical characteristics of the patients,such as surgical methods,pathology,staging and treatment methods,were summarized.To assess whether adjuvant therapy is needed after radical hysterectomy in intermediate-risk cervical cancer patients who do not meet the Sedlis criteria,in order to provide recommendations for the application of clinical treatment plans.MethodsCollected and analyzed the clinical data of patients with cervical squamous cell carcinoma,adenocarcinoma or adenosquamous carcinoma who underwent initial surgery between January 2010 to December 2018,including general information,surgical methods,staging,pathological features and adjuvant therapy.Statistical Analysis applied SPSS 26.0,chi-square test,fisher test and t test were used to compare the differences in clinical characteristics,and univariate and multivariate analyses were performed with Cox proportional hazards regression models.Recurrence-free survival and overall survival were compared between the different groups.Results1.Univariate and multivariate analysis revealed that tumor size was is an independent poor prognostic factor for RFS and OS,and LVSI was a risk factor for overall survival.2.The median follow-up time was 59 months(IQR 2 to 113).Compared with surgery alone,surgery plus adjuvant therapy did not prolong recurrence-free survival and overall survival.The 3-year recurrence-free survival rates of the surgery-only group and the adjuvant therapy group were 96.1%and 93.4%,respectively(P=0.386),and the 3-year overall survival rates were 98.0%and 97.0%,respectively(P=0.854).3.After PSM of 250 patients,there were no significant differences in 3-year recurrence-free survival rate and 3-year overall survival rate between NAT group and AT group.4.Subgroup analysis:61 patients with a single intermediate risk factor(adenocarcinoma or adenosquamous carcinoma,tumor size,LVSI,deep stromal invasion,moderately and poorly differentiated)had no significant benefit from postoperative adjuvant therapy.In 152 cases with at least two IRF,adjuvant therapy did not improve RFS and OS(P>0.05).5.159 patients with squamous cell carcinoma,the 3-year recurrence-free survival rates of the NAT group and the AT group were 93.5%and 95.5%,respectively,(P=0.386),and the 3-year overall survival rates of the two groups were 96.8%and 97.7%,respectively,(P=0.376).Conclusion1.Tumor≥2cm is an independent risk factor for the prognosis of cervical cancer patients.2.For patients with early-stage intermediate-risk cervical cancer who do not meet the Sedlis criteria,adjuvant therapy has no benefit.Innovation and DeficienciesThis study compared the effects of radical surgery alone and radical surgery combined with postoperative adjuvant therapy in patients with early-stage intermediate-risk cervical cancer who did not meet the Sedlis criteria.It has guiding significance for clinical treatment.The study was a retrospective research,so the level of evidence is low.The sample size of the subjects included in this study was small,and it was a single-center study.This study has a high loss to follow-up rate,and there is a certain degree of bias.