# Comprehensive Comparison of Surgery Followed by Radiotherapy and Radical Radiotherapy for Cervical Cancer: A Multicenter Retrospective Propensity-Score-Matched Analysis

## TL;DR

This study compares two cervical cancer treatments and finds they have similar survival rates, but one is more cost-effective in China.

## Contribution

The study provides real-world evidence that radical radiotherapy is more cost-effective than surgery followed by radiotherapy for cervical cancer in China.

## Key findings

- Survival rates were similar between surgery followed by radiotherapy and radical radiotherapy.
- Radical radiotherapy was found to be more cost-effective in China based on economic analysis.
- Subgroup analysis showed improved progression-free survival for adenocarcinoma patients with radical radiotherapy.

## Abstract

Medical guidelines generally recommend surgery for early-stage cervical cancer and radiation therapy for advanced stages; however, personal preferences and other factors often lead some patients to choose surgery followed by radiation instead of starting directly with radiation therapy. This study aimed to compare the medical success, patient safety, and financial costs of these two treatment paths using real-world patient information. The results showed that patients experienced similar survival rates regardless of which of the two treatments they received. However, starting directly with comprehensive radiation therapy proved to be a better financial value for patients in China. By demonstrating that both methods are equally effective for survival but differ in overall cost, this research provides valuable information to help doctors personalize care for their patients. Furthermore, it offers clear data to assist national health insurance programs in making better coverage decisions, ensuring that medical resources are used wisely and efficiently to benefit society as a whole.

Background: While surgery and radiotherapy are the standard of care for patients with cervical cancer (CC), debate persists regarding the choice of whether treatment should consist of surgery followed by radiotherapy or initial direct radical radiotherapy. The present study was therefore devised to compare real-world clinical outcomes and economic assessments associated with these different treatment approaches. Methods: Six tertiary medical centers retrospectively identified patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage I-IVA CC who underwent surgery followed by radiotherapy (surgery–radiotherapy group) or radical radiotherapy (radiotherapy group) between 2015 and 2023 in China. The progression-free and overall survival (PFS and OS) of these patients were compared using Kaplan–Meier and propensity-score-weighted proportional risk models. Economic analyses were also conducted based on patient follow-up for up to 8 years from the start of treatment. Results: A total of 980 patients receiving surgery–radiotherapy and radiotherapy were identified for matching. Propensity score weighting revealed no significant statistical differences in PFS (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.44–1.28; p = 0.29) and OS (HR, 0.49; 95% CI, 0.20–1.21; p = 0.12) when comparing these groups. Subgroup analysis found differences in PFS (HR, 0.17; 95% CI, 0.04–0.77; p = 0.02) among adenocarcinoma. Economic analyses revealed that the incremental cost-effectiveness ratio of the surgery–radiotherapy group versus the radiotherapy group was $40,831/quality-adjusted life-year (QALY), which is higher than the Chinese willingness-to-pay threshold of $35,841/QALY. Conclusions: Survival outcomes were similar for patients with CC who underwent surgery–radiotherapy and radiotherapy. Further, radical radiotherapy may be cost-effective for such patients considering economic factors in China.