title: Clinical Role of Adjuvant Chemotherapy after Radical Hysterectomy for FIGO Stage IB-IIA Cervical Cancer: Comparison with Adjuvant RT/CCRT Using Inverse-Probability-of-Treatment Weighting.
abstract: OBJECTIVE
  To evaluate the clinical role of adjuvant chemotherapy (AC) in FIGO stage IB-IIA cervical cancer patients.
  
  
  METHODS
  A cohort of 262 patients with cervical cancer who received radical hysterectomy (RH) and adjuvant therapy at Asan Medical Center between 1992 and 2012 was enrolled. In this cohort, 85 patients received adjuvant chemotherapy (AC), and 177 received adjuvant radiotherapy or concurrent chemoradiation therapy (AR). Oncologic outcomes and adverse events in both treatment arms were compared using weighted Cox proportional hazards regression models with inverse-probability-of-treatment weighting (IPTW) to reduce the impact of treatment selection bias and potential confounding factors.
  
  
  RESULTS
  During a 46.8-month median follow-up duration, 39 patients (14.9%) had recurrences, and 18 patients (6.9%) died of disease. In multivariate analysis, the hazard ratio (HR) for recurrence and death was not significantly different in patients in either treatment arm (p=0.62 and 0.12, respectively). Also, after IPTW matching, the HR for recurrence did not significantly differ between the arms (HR 1.57, 95% CI 0.68-3.62, p=0.29). Similarly, disease-free survival and overall survival were not significantly different between the arms (p=0.47 and 0.13, respectively). In addition, patients with AC had a much lower prevalence of long-term complications (lymphedema: n=8 (9.4%) vs. 46 (26.0%), p=0.03; ureteral stricture: n=0 vs. 9 (6.2%), p=0.05).
  
  
  CONCLUSIONS
  Patients with FIGO stage IB-IIA cervical cancer can benefit from AC after RH with fewer long-term complications and non-inferior therapeutic effect to AR. Chemotherapy may therefore be an alternative adjuvant treatment option for cervical cancer, particularly in younger patients.
authors.affiliation: Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Phill-Seung
authors.initials: PS
authors.lastname: Jung
authors.affiliation: Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Dae-Yeon
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Shin-Wha
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jeong-Yeol
authors.initials: JY
authors.lastname: Park
authors.affiliation: Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Dae-Shik
authors.initials: DS
authors.lastname: Suh
authors.affiliation: Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jong-Hyeok
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Yong-Man
authors.initials: YM
authors.lastname: Kim
authors.affiliation: Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Young-Tak
authors.initials: YT
authors.lastname: Kim
authors.affiliation: Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Joo-Hyun
authors.initials: JH
authors.lastname: Nam
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*