Real-World Guideline Concordance and Potential Overtreatment Following Primary Radical Hysterectomy for Early-Stage Cervical Cancer
- 1Department of Obstetrics and Gynecology, Faculty of Medicine, Trakya University, Edirne 22030, Turkey
- 2Department of Biophysics, Faculty of Medicine, Trakya University, Edirne 22030, Turkey
- 3Uzunköprü State Hospital, Uzunköprü, Edirne 22200, Turkey
Abstract
Background/Objectives: International guidelines recommend risk-adapted postoperative management in early-stage cervical cancer; however, the extent to which these recommendations are implemented in routine clinical practice remains incompletely characterized, particularly among patients without high-risk pathological features. This study evaluated real-world concordance with the 2023 European Society of Gynecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology (ESGO/ESTRO/ESP) recommendations and investigated the clinical implications of potential overtreatment. Methods: We retrospectively evaluated a single-center cohort of 135 patients treated with primary radical hysterectomy for early-stage cervical cancer at our institution. Postoperative pathological risk factors were used to stratify patients in accordance with the 2023 ESGO/ESTRO/ESP guidelines. Postoperative management was classified as guideline-concordant or potential overtreatment. Disease-free survival (DFS) and overall survival (OS) were assessed by Kaplan–Meier analysis and univariable Cox proportional hazards regression. Results: The high-risk group comprised 50 patients (37.0%), and the non-high-risk group comprised the remaining 85 patients (63.0%). Among non-high-risk patients, 28 (32.9%) received guideline-concordant postoperative management, whereas 57 (67.1%) received treatment classified as potential overtreatment. The distribution of postoperative treatment intensity differed significantly according to guideline-concordance status (p < 0.001). However, DFS did not differ significantly between the guideline-concordant and potential overtreatment groups (log-rank p = 0.62; hazard ratio [HR] = 1.38, 95% confidence interval [CI] 0.38–5.06), nor did OS (log-rank p = 0.85; HR = 1.09, 95% CI 0.42–2.84). Conclusions: Postoperative management showed substantial variation among patients without high-risk pathological features, with potential overtreatment observed in approximately two-thirds of this cohort. No statistically significant differences in DFS or OS were observed between the groups; however, the limited number of events and wide confidence intervals preclude exclusion of clinically meaningful treatment effects.
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BibTeX
@article{ates2026realworld,
title = {{Real-World Guideline Concordance and Potential Overtreatment Following Primary Radical Hysterectomy for Early-Stage Cervical Cancer}},
author = {Sinan Ateş and Arzu Ay and Gonca Büşra Çoker and Nisa Gjergjizi and Rona Luboteni and Füsun Varol and N. Cenk Sayın},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207952},
url = {https://www.mdpi.com/2077-0383/15/20/7952},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Real-World Guideline Concordance and Potential Overtreatment Following Primary Radical Hysterectomy for Early-Stage Cervical Cancer
AU - Sinan Ateş
AU - Arzu Ay
AU - Gonca Büşra Çoker
AU - Nisa Gjergjizi
AU - Rona Luboteni
AU - Füsun Varol
AU - N. Cenk Sayın
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207952
UR - https://www.mdpi.com/2077-0383/15/20/7952
AB - Background/Objectives: International guidelines recommend risk-adapted postoperative management in early-stage cervical cancer; however, the extent to which these recommendations are implemented in routine clinical practice remains incompletely characterized, particularly among patients without high-risk pathological features. This study evaluated real-world concordance with the 2023 European Society of Gynecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology (ESGO/ESTRO/ESP) recommendations and investigated the clinical implications of potential overtreatment. Methods: We retrospectively evaluated a single-center cohort of 135 patients treated with primary radical hysterectomy for early-stage cervical cancer at our institution. Postoperative pathological risk factors were used to stratify patients in accordance with the 2023 ESGO/ESTRO/ESP guidelines. Postoperative management was classified as guideline-concordant or potential overtreatment. Disease-free survival (DFS) and overall survival (OS) were assessed by Kaplan–Meier analysis and univariable Cox proportional hazards regression. Results: The high-risk group comprised 50 patients (37.0%), and the non-high-risk group comprised the remaining 85 patients (63.0%). Among non-high-risk patients, 28 (32.9%) received guideline-concordant postoperative management, whereas 57 (67.1%) received treatment classified as potential overtreatment. The distribution of postoperative treatment intensity differed significantly according to guideline-concordance status (p < 0.001). However, DFS did not differ significantly between the guideline-concordant and potential overtreatment groups (log-rank p = 0.62; hazard ratio [HR] = 1.38, 95% confidence interval [CI] 0.38–5.06), nor did OS (log-rank p = 0.85; HR = 1.09, 95% CI 0.42–2.84). Conclusions: Postoperative management showed substantial variation among patients without high-risk pathological features, with potential overtreatment observed in approximately two-thirds of this cohort. No statistically significant differences in DFS or OS were observed between the groups; however, the limited number of events and wide confidence intervals preclude exclusion of clinically meaningful treatment effects.
SN - 2077-0383
ER -