Should All Cervical Cancer Patients with Positive Lymph Node Receive Definitive Radiotherapy: A Population-Based Comparative Study

Objective: The optimal initial treatment for lymph node metastases (LNM) cervical cancer remains a subject of controversy. This study aimed to investigate the association between surgery plus postoperative radiotherapy (PORT) and definitive radiotherapy (RT), and the prognosis of patients with LNM cervical cancer. Methods: Patients with positive lymph nodes (PLNs) in 2009 FIGO stage I-III cervical cancer were selected from SEER database. Kaplan-Meier and log-rank analysis were utilized to assess survival outcomes. Cox regression and Interaction analyses were used to compare the survival benefits. Results: 2936 patients were included in this study. Multivariate analysis revealed that the choice of primary treatment significantly influenced both cancer-specific survival (CSS) and overall survival (OS), serving as an independent prognostic factor for patients with LNM. After adjusting for imbalanced variables, surgery plus PORT significantly improved CSS and OS in the stage I-II and PLNs ≤ 5 subgroups. However, no significant difference was observed between the two treatment modalities in patients with stage III and PLNs > 5 subgroups. Through interaction analysis, it was observed that patients with stage I-II and PLNs ≤ 5 exhibited a significant survival benefit from surgery plus PORT. Conclusion: For cervical cancer patients at FIGO stage I-II or those with PLNs ≤ 5, combining surgery with PORT could lead to improved outcomes. However, this approach did not apply to those at stage III or individuals with PLNs > 5. Therefore, a comprehensive assessment of LNM and local tumor spread should guide rationalized treatment options when managing patients presenting LNM.