Efficacy comparison of concurrent chemoradiotherapy alone versus concurrent chemoradiotherapy plus adjuvant chemotherapy in stage III Locally Advanced Cervical Cancer: A single-center, retrospective observational cohort study

OBJECTIVE: This study evaluated efficacy and safety of concurrent chemoradiotherapy (CCRT) versus CCRT plus adjuvant chemotherapy (CCRT+ACT) in 2018 Federation International of Gynecology and Obstetrics (FIGO) Stage III locally advanced cervical cancer (LACC) patients. This study provides clinical evidence to optimize treatment strategies for stage III LACC. METHODS: A total of 72 patients diagnosed with stage III LACC were retrospectively enrolled from the Cancer Hospital of Guangdong Medical University between May 2018 and May 2024. They were divided into the CCRT group (n = 33) and the CCRT+ACT group (n = 39). Survival endpoints were analyzed using the Kaplan-Meier method with log-rank tests, and Cox proportional hazards regression models were applied to identify prognostic factors. RESULTS: The 3-year OS (79.5% vs. 63.6%,P = 0.238) and PFS (56.4% vs. 45.5%,P = 0.706) rates showed no significant differences between the CCRT+ACT and CCRT groups. Kaplan-Meier survival analysis suggested that a positive lymph node size ≥ 10 mm (relative to a < 10 mm reference) may be associated with an increased hazard for mortality (HR = 8.235; P = 0.020) and disease progression (HR = 2.986; P = 0.020). Furthermore, abnormal post-brachytherapy SCC-Ag levels (> 1.5 ng/mL vs. ≤ 1.5 ng/mL reference) appeared to be strongly linked to adverse OS (HR = 13.641; P < 0.001) and PFS (HR = 4.722; P = 0.007). Regarding safety, CCRT+ACT did not increase grade 3-4 toxicities, suggesting a manageable safety profile. CONCLUSION: While CCRT+ACT did not significantly improve survival in the un-selected stage III LACC population, a positive lymph node size of ≥ 10 mm and elevated post-brachytherapy SCC-Ag levels may serve as important prognostic indicators for adverse outcomes. These findings are hypothesis-generating, suggesting that integrating these factors into clinical risk assessment might aid in refining the identification of high-risk subsets who could potentially benefit from more personalized, intensified adjuvant strategies in future prospective trials.