Efficacy of Chemotherapy Alone in Patients With Poor-differentiated Early-stage Cervical Cancer

The Efficacy of Chemotherapy Alone in Patients With Poor-differentiated Early-stage Cervical Cancer But Without the Criteria for Adjuvant Radiotherapy According to NCCN Guidelines

This study is aimed to enroll patients with early-stage cervical cancer (FIGO 2018 IB1-IB2) who undergo radical hysterectomy and the postoperative pathology doesn't meet Sedlis criteria or the "four-factor" model but with poorly differentiated squamous/adenocarcinoma/adenosquamous carcinoma. Patients will be randomly divided into two groups in a 1:1 ratio. The experimental group received 4 courses of paclitaxel and cisplatin (once every 3 weeks) for adjuvant chemotherapy within 4 weeks after surgery, while the control group don't not receive any adjuvant therapy but only received regular follow-up. The disease status of all patients will be evaluated within 4 weeks after the end of all treatment and every 12 weeks thereafter, including gynecological examination, laboratory indicators, imaging evaluation, and the prognosis of the two groups will be compared.

Inclusion Criteria:

1. The age of patients is 18-70 years old.
2. Patients with cervical cancer who undergo radical hysterectomy and pelvic lymphadenectomy as initial treatment (including laparoscopic and abdominal surgery).
3. Clinical stage is IB1-IB2 according to FIGO 2018 stage.
4. The postoperative pathological type is squamous cell carcinoma/adenocarcinoma/adenosquamous carcinoma.
5. The degree of tumor differentiation is poorly differentiated.
6. Do not meet the Sedlis criteria or the four-factor model, but meet one of the following factors: ① LVSI (+); ② tumor diameter > 2cm; ③ Depth of cervical stromal invasion > superficial 1/3; (4) adenocarcinoma.

Exclusion Criteria:

1. Postoperative pathological stage ≥IIA (according to the 2018 FIGO staging system).
2. Patients with the following high risk factors: ① lymph node metastasis; ② parametrial involvement; ③ positive surgical margin; ④ vaginal involvement.
3. Patients received neoadjuvant chemotherapy.
4. There was evidence of distant metastasis on preoperative imaging examination.
5. Patients received postoperative radiotherapy.
6. History of abdominal or pelvic radiotherapy.
7. Patients with other malignant tumors.
8. Patients with missing or partially missing clinical, surgical, and pathological data were lost to follow-up.