Aiyuan Wu, Remila Rezhake, Ziyin Huang, Guzhalinuer Abulizi, Li Li, Youlin Qiao, Shaojie Zhao
ObjectiveThis study aimed to validate the prognostic discriminatory power of the revised International Federation of Gynecology and Obstetrics (FIGO) 2018 staging system and to evaluate the association between regional lymph node resection (RLNR) and survival in cervical cancer (CC) patients who underwent RLNR followed by chemotherapy and radiotherapy.MethodsIn this retrospective cohort study utilizing the Surveillance, Epidemiology, and End Results (SEER) database (2000-2018), patients were categorized into early-stage (IA/IB1-IB2/IIA1) and locally advanced-stage (IB3/IIA2-IIB/III/IVA) groups. Survival outcomes were analyzed using Kaplan-Meier, univariate and multivariate Cox regression (including time-dependent), and year-of-diagnosis stratified analyses, applied to crude, inverse probability of treatment weighting (IPTW)-weighted, and propensity score matching (PSM)-matched models.ResultsThe FIGO 2018 system revealed significant survival differences between IB1 vs IB2 and IIIC1 vs IIIA/IIIB (all p < 0.001). In early-stage patients, RLNR conferred no significant survival benefit. However, in locally advanced-stage patients, RLNR with primary surgery was associated with better survival than RLNR alone. In the cohort without primary surgery, RLNR alone was consistently identified as a prognostic factor versus non-surgery across all three analytical models (IPTW as primary, PSM as sensitivity; all p<0.001). The hazard ratios for RLNR alone versus non-surgery were all below 1.000, and year-of-diagnosis stratified analyses further supported this protective association, with consistently directional estimates.ConclusionThis study suggested the prognostic value of the FIGO 2018 staging system and hypothesized that RLNR is a prognostic factor for better survival compared with chemotherapy and radiotherapy alone in locally advanced-stage CC, although the limitations of a retrospective study must be acknowledged.