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J Gynecol Oncol. 2019 May;30(3):e41. English. Original Article. https://doi.org/10.3802/jgo.2019.30.e41
Albert A , Allbright R , Lee A , Vijayakumar S .
Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA. aalbert@umc.edu
Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA.
Abstract

Objective

Adjuvant hysterectomy following chemoradiation (CRT) is a treatment option used worldwide for early-stage cervical cancer but the benefit of hysterectomy in this setting is unclear. An analysis of the National Cancer Database (NCDB) was performed to identify patterns of care and determine the survival impact of adjuvant hysterectomy.

Methods

The NCDB was queried for patients with International Federation of Gynecology and Obstetrics stage IB2 to IIA2 cervical cancer diagnosed from 2010–2014 who underwent preoperative concurrent chemoradiation followed by hysterectomy (CRT+S) or definitive CRT. Overall survival (OS) curves were generated using the Kaplan-Meier method and compared via the log-rank test. Univariable and multivariable logistic regression and Cox regression were used to determine covariables associated with utilization and OS.

Results

There were 1,546 patients who met the study criteria, of which 1,407 (91.0%) received concurrent CRT alone and 139 (9.0%) received CRT+S. Four-year OS for the CRT+S group was 82.2% and 74.9% for the CRT group (p=0.036). On subgroup analysis by lymph node status, the 4-year OS for patients without positive pelvic or para-aortic lymph nodes was 84.9% in the CRT+S group vs. 77.8% in the CRT group (p=0.072). On multivariable Cox regression, there was no difference in survival based on treatment group (hazard ratio=0.63; 95% confidence interval=0.06–1.04; p=0.069).

Conclusion

We found from this hospital database that completion hysterectomy is used infrequently and did not result in a significant survival difference when accounting for other factors.

Copyright © 2019. Korean Association of Medical Journal Editors.