KEY POINTS
- This multicentre retrospective cohort included 1,171 patients with FIGO 2018 stage IB3–IVA cervical cancer treated at 17 Chinese hospitals with definitive external-beam radiotherapy, brachytherapy, and concurrent platinum chemotherapy; 188 received induction chemotherapy and 983 did not.
- In the overall cohort, induction chemotherapy was not associated with significant improvements in 5-year overall survival (79.3% vs 78.0%; p=0.7) or 5-year progression-free survival (71.2% vs 75.6%; p=0.2). No significant benefit emerged after propensity score matching.
- Recursive partitioning identified a low-risk subgroup with stage I–II squamous cell carcinoma. In this group, induction chemotherapy was associated with worse 5-year overall survival (79.7% vs 89.6%; p=0.013) and 5-year progression-free survival (69.3% vs 81.4%; p=0.05).
- Among patients receiving induction chemotherapy, an induction-course-per-day value above 0.05 was associated with better 5-year overall survival (80.6% vs 66.7%; p<0.001) and 5-year progression-free survival (73.2% vs 64.1%; p=0.048) than less-dense delivery.
- In the high-risk stage III–IVA subgroup, dense induction chemotherapy was associated with higher 5-year overall survival than no induction chemotherapy (90.0% vs 71.1%; p<0.001), although the progression-free survival difference was not significant.
CLINICAL TAKEAWAY
Induction chemotherapy should not be interpreted as uniformly beneficial across locally advanced cervical cancer. The study suggests that treatment density and baseline risk may influence outcomes, but its retrospective design, non-standardized regimens, small induction subgroups, and conflict with randomized INTERLACE evidence mean the findings are clinically important but not practice-changing.