Comparative Effectiveness of Radical Surgery versus Concurrent Chemoradiotherapy in Stage IB3, IIA2, or IIICr Cervical Cancer: A Prospective, Multicenter, Propensity Score-Matched Cohort Study

Background While concurrent chemoradiotherapy (CCRT) is the standard first-line treatment, radical surgery (RS) is frequently preferred in China, despite unclear comparative efficacy. The role of minimally invasive surgery also remains controversial and requires further validation. These persistent uncertainties underscore the need to advance research into LACC treatment strategies. Methods We conducted a multicenter prospective cohort study at three tertiary teaching hospitals in Shanghai, including 246 patients with specific locally advanced cervical cancer (LACC; FIGO 2018 stages IB3, IIA2, or IIICr). We compared overall survival (OS), progression-free survival (PFS), adverse events (AEs), and two-year quality-adjusted life years (QALYs) between RS (n = 198) and definitive CCRT (n = 48), and further compared tumor-free laparoscopic RS (n = 119) with open RS (n = 79). Propensity score matching (PSM) was applied to reduce potential confounding. Subgroup analyses were conducted according to key clinical factors, and sensitivity analyses were performed to assess the robustness of the results. Results After PSM, there were no significant differences in OS or PFS between the RS and the definitive CCRT groups (Two-year OS: 92% [86–97%] vs. 91% [82–100%]; Two-year PFS: 79% [72–87%] vs. 78% [66–91%]), nor between the tumor-free laparoscopic and the open RS groups (Two-year OS: 97% [93–100%] vs. 91% [84–98%]; Two-year PFS: 82% [74–92%] vs. 78% [69–89%]). Subgroup and sensitivity analyses yielded consistent findings. Two-year QALYs were comparable between the RS and the definitive CCRT groups (23.55 [22.54, 24.00] vs. 23.53 [22.60, 23.80] months; w = 3148, p = 0.074), but significantly higher in the tumor-free laparoscopic RS group than in the open RS group (24.00 [23.52, 24.00] vs. 23.52 [21.77, 24.00] months; w = 3060, p = 0.003). Conclusions RS and definitive CCRT provided comparable survival outcomes and two-year QALYs in specific LACC patients (FIGO 2018 stages IB3, IIA2, or IIICr). Within the surgical cohort, tumor-free laparoscopic RS achieved similar survival outcomes as open RS but offered better two-year QoL benefits, supporting its role as a potential surgical option under strict oncologic principles.