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Objective <p>To evaluate the efficacy and safety of adjuvant treatment strategies following radical hysterectomy for intermediate-risk, early-stage cervical cancer using a reconstructed HR Hazard ratio (HR) meta-analysis.</p> Methods <p>A systematic review and meta-analysis was conducted by the Japan Society of Gynecologic Oncology Cervical Cancer Committee. PubMed/MEDLINE, Cochrane, and Ichushi were searched on July 29, 2025, using “cervical cancer,” “intermediate-risk,” and “adjuvant therapy.” Studies comparing adjuvant radiotherapy alone (RT) with no further treatment (NFT), concurrent chemoradiotherapy (CCRT), or systemic chemotherapy (CT) after conventional radical hysterectomy were independently reviewed by two reviewers. Primary outcomes were survival and grade ≥ 3 treatment-related toxicities.</p> Results <p>Of 402 screened articles, 24 studies comprising 9278 patients were included: RT (<i>n</i> = 4167), NFT (<i>n</i> = 2057), CCRT (<i>n</i> = 2118), and CT (<i>n</i> = 936). The majority of studies enrolled patients with ≥ 2 Sedlis risk factors (median 84.2%, interquartile range 44.7–100%). Compared with NFT, RT significantly improved recurrence-free survival (HR 0.61, <i>P</i> &lt; 0.01) but did not confer a significant overall survival benefit (HR 0.77, <i>P</i> = 0.09). RT also reduced recurrence in patients with a single risk factor (HR 0.55, <i>P</i> &lt; 0.01). RT showed no survival disadvantage compared with CCRT (recurrence-free survival: HR 1.26; overall survival: HR 1.07), and survival outcomes were comparable between RT and CT (recurrence-free survival: HR 0.86; overall survival: HR 1.16) (all <i>P</i> &gt; 0.05). Grade ≥ 3 toxicities were significantly lower with RT than with CCRT (odds ratio 0.25; <i>P</i> &lt; 0.001).</p> Conclusion <p>Adjuvant RT represents an effective and well-tolerated postoperative strategy for intermediate-risk, early-stage cervical cancer. Adjuvant CT may represent a potential alternative option.</p>

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Optimal adjuvant strategy in intermediate-risk cervical cancer: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月21日

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  • Akira Yokoi,
  • Hiroko Machida,
  • Mika Okazawa-Sakai,
  • Koji Nishino,
  • Hanae Nishino,
  • Mizue Itoi,
  • Takumi Mitamura,
  • Fumiaki Isohashi,
  • Keisuke Tsuchida,
  • Haruya Saji,
  • Satoe Fujiwara,
  • Noriko Ii,
  • Miho Watanabe,
  • Tadaaki Nishikawa,
  • Satoshi Nakagawa,
  • Michiko Kodama,
  • Shinya Sato,
  • Kazuhiro Takehara,
  • Tohru Morisada,
  • Shin-ei Noda,
  • Munetaka Takekuma,
  • Hiroaki Kajiyama,
  • Hideki Tokunaga,
  • Tsukasa Baba,
  • Yoichi Kobayashi,
  • Aikou Okamoto

摘要

Objective

To evaluate the efficacy and safety of adjuvant treatment strategies following radical hysterectomy for intermediate-risk, early-stage cervical cancer using a reconstructed HR Hazard ratio (HR) meta-analysis.

Methods

A systematic review and meta-analysis was conducted by the Japan Society of Gynecologic Oncology Cervical Cancer Committee. PubMed/MEDLINE, Cochrane, and Ichushi were searched on July 29, 2025, using “cervical cancer,” “intermediate-risk,” and “adjuvant therapy.” Studies comparing adjuvant radiotherapy alone (RT) with no further treatment (NFT), concurrent chemoradiotherapy (CCRT), or systemic chemotherapy (CT) after conventional radical hysterectomy were independently reviewed by two reviewers. Primary outcomes were survival and grade ≥ 3 treatment-related toxicities.

Results

Of 402 screened articles, 24 studies comprising 9278 patients were included: RT (n = 4167), NFT (n = 2057), CCRT (n = 2118), and CT (n = 936). The majority of studies enrolled patients with ≥ 2 Sedlis risk factors (median 84.2%, interquartile range 44.7–100%). Compared with NFT, RT significantly improved recurrence-free survival (HR 0.61, P < 0.01) but did not confer a significant overall survival benefit (HR 0.77, P = 0.09). RT also reduced recurrence in patients with a single risk factor (HR 0.55, P < 0.01). RT showed no survival disadvantage compared with CCRT (recurrence-free survival: HR 1.26; overall survival: HR 1.07), and survival outcomes were comparable between RT and CT (recurrence-free survival: HR 0.86; overall survival: HR 1.16) (all P > 0.05). Grade ≥ 3 toxicities were significantly lower with RT than with CCRT (odds ratio 0.25; P < 0.001).

Conclusion

Adjuvant RT represents an effective and well-tolerated postoperative strategy for intermediate-risk, early-stage cervical cancer. Adjuvant CT may represent a potential alternative option.