Le-Le Chang,1,* Yu-Qin Wang,1,* Xue-Mei Zhang,2,* Jing Liu,1 Le-Le Zang,1 Li Li,1 Lan Luo,1 Fei Zhu,1 Ming-Xuan Zhu,1 Hui-Qi Zhang,1 Ya-Xin Kang,1 Ling Lin,1,3 Zhi-Cong Wu,4 Qin Xu1 

1Departments of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital (Fujian Branch of Fudan University Shanghai Cancer Center), Fuzhou, Fujian, 350014, People’s Republic of China; 2Department of Radiation Oncology, Quzhou People’s Hospital, Quzhou, Zhejiang, 323000, People’s Republic of China; 3Fujian Medical University, Fuzhou, Fujian, 350014, People’s Republic of China; 4Gynecology Department, The First Hospital of PuTian City, Putian, Fujian, 351100, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Qin Xu; Zhi-cong Wu, Email xuqin@fjmu.edu.cn; wzc122617@qq.com

Background: A growing number of patients with early-stage cervical cancer opt for local tumor resection to preserve the uterus. Nevertheless, there is still a dearth of long-term comparisons between local tumor destruction/excision (LTD/LTE) and total hysterectomy(TH), and the optimal target population for local tumor excision remains uncertain.
Methods: A multicenter retrospective study utilizing the Surveillance, Epidemiology, and End Results (SEER) database to compare the long-term outcomes between LTD/LTE and TH in stage IA cervical cancer patients was conducted. A 1:1 propensity score matching (PSM) method was employed to obtain matched cohorts with similar baseline characteristics in the LTD/LTE and TH groups. Kaplan-Meier analysis was used to compare overall survival (OS) and cancer-specific survival (CSS) between the two groups. The Cox proportional hazard models were employed to identify factors associated with OS and CSS.
Results: This study comprised a total of 6382 cervical cancer patients, with 1759 undergoing LTD/LTE and 4623 undergoing TH. After PSM, a significant difference was observed in OS (P=0.030) between the two groups, while no significant difference was found in CSS (P=0.110). Subgroup analysis of patients with stage IA1 (OS: P=0.018; CSS: P=0.230) and IA2 (OS: P=0.071; CSS: P=0.240) revealed no significant differences in OS and CSS between the two groups. Older age (≥ 50 years) [HR=2.20; 95% CI: 2.20– 3.30)] and histological types other than squamous cell carcinoma and usual-type adenocarcinoma [HR=4.40; 95% CI:1.80– 11.10] favored TH for better OS, whereas well-differentiated (grade I–II) [HR=0.40; 95% CI: 0.20– 0.90] patients were more suitable for LTD/LTE, leading to improved OS and CSS outcomes.
Conclusion: It was determined that the long-term outcomes of LTD/LTE are comparable to TH and can serve as a safe option for selected patients with stage IA cervical cancer. Future large prospective studies are required to validate our findings and explore differences in recurrence patterns between the two treatment strategies.

Keywords: cervical cancer, local tumor destruction/excision, total hysterectomy, propensity score matching analysis, SEER database, long-term outcomes