Background:For early-stage cervical cancer, surgery constitutes the standard therapeutic approach. Whether adjuvant radiotherapy and chemotherapy should be administered to patients with intermediate- or high-risk pathological characteristics continues to generate debate. Controversy persists regarding the ideal postoperative adjuvant treatment approach for this patient population. Using the Surveillance, Epidemiology, and End Results (SEER) database, this study compared survival outcomes among early-stage cervical cancer patients managed with observation, postoperative radiotherapy (PORT), or postoperative concurrent chemoradiotherapy (POCRT). Methods:Patients with stage I-II cervical cancer who underwent surgical treatment from 2004 to 2020 were identified through the SEER database. Patients were classified into three cohorts based on their postoperative management: observation, PORT, and POCRT. Overall survival (OS) and cancer-specific survival (CSS) were assessed through Cox proportional hazards regression, competing risk modeling, Kaplan-Meier survival curves, and subgroup analyses. Results:Among 13,687 eligible patients, 9,868 underwent postoperative observation, 1,237 received PORT, and 2,582 received POCRT. In the unmatched overall cohort, patients receiving adjuvant therapy had higher mortality rates and higher-risk baseline profiles. Stratified analysis demonstrated that postoperative observation was associated with better survival than PORT and POCRT in stage I patients (P<0.001), whereas POCRT was associated with better survival compared with observation and PORT in stage II patients (P=0.04). Subgroup analyses suggested associations between postoperative adjuvant therapy and better survival among patients with T2 disease, N1 status, multiple primary malignancies (≥2), or age ≥60 years. Conclusions:For patients with early-stage cervical cancer, the decision regarding PORT and chemotherapy should remain guided by current guideline-based risk stratification. Our findings suggest that tumor (T) stage, node (N) stage, multiple primary malignancies, and age warrant further investigation as potential effect modifiers.
Background:Although programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors plus chemotherapy (PC) has improved outcomes in advanced squamous non-small cell lung cancer (NSCLC), the consistency of survival benefit and the predictive value of PD-L1 expression remain uncertain, particularly following the publication of several recent pivotal phase 3 randomized controlled trials (RCTs). This study aimed to systematically evaluate the efficacy and safety of PC versus chemotherapy alone in patients with stage IIIBIV squamous NSCLC and to assess the predictive value of PD-L1 expression. Methods:PubMed, EMBASE, Web of Science, Scopus, ScienceDirect, and the Cochrane Library were systematically searched up to May 25, 2026. Phase 3 RCTs comparing PC with chemotherapy alone in patients with stage IIIB-IV squamous NSCLC were included. Risk of bias was assessed using the Cochrane tool, and evidence certainty was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Hazard ratios (HRs) were pooled for time-to-event outcomes, and risk ratios (RRs) were calculated for binary outcomes using fixed- or random-effects models according to heterogeneity. Results:Fourteen phase 3 RCTs involving 4,481 patients (2,466 patients in the PC arm and 2,015 patients in the chemotherapy arm) were included. The certainty of evidences ranged from moderate to high. Patients receiving PC demonstrated significantly improved overall survival (OS) {HR: 0.73 [95% confidence interval (CI): 0.67, 0.79], P<0.001} and progression-free survival (PFS) [HR: 0.54 (95% CI: 0.48, 0.60), P<0.001] compared with those treated with chemotherapy alone. OS benefits in the PC group were observed across a follow-up period of 6 to 60 months, while PFS improvement was evident from 6 to 24 months. Subgroup analysis indicated that patients with a PD-L1 expression ≥50% experienced superior survival outcomes with PC. Regarding tumor response, PC was associated with a longer duration of response [HR: 0.48 (95% CI: 0.41, 0.55), P<0.001] and a higher objective response rate [RR: 1.50 (95% CI: 1.40, 1.61), P<0.001]. Safety analysis revealed a higher incidence of total and grade 3-5 immune-related adverse events (irAEs). Clinically important adverse events (AEs) were also increased, including treatment-emergent adverse events (TEAEs)/treatment-related adverse events (TRAEs) leading to discontinuation and TEAEs leading to death, highlighting the need for careful monitoring. Conclusions:PC improves survival and tumor response in stage IIIB-IV squamous NSCLC, particularly in patients with higher PD-L1 expression, but increases irAEs, warranting careful benefit-risk assessment and toxicity monitoring.
Background:As a primary curative treatment for locally advanced cervical cancer, radiotherapy is frequently undermined by radioresistant tumor cells that evade cell death and subsequently drive post-treatment tumor progression. This study aimed to identify candidate genes associated with radioresistance in cervical cancer and to explore their potential in predicting unfavorable outcomes among radioresistant patients, thereby providing a reference for future research. Methods:We screened for co-expressed genes using transcriptomic data from radiation non-complete response (NCR) cervical cancer patients in Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) databases. Cox regression analyses were conducted to identify the most significant radioresistance-associated genes for constructing a prognostic model. The predictive performance of this model was further validated through logistic regression, weighted gene co-expression network analysis (WGCNA), and pan-cancer analyses. Quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) was performed to quantify the expression levels of key genes in cervical cancer tissue samples from radiosensitive and radioresistant patients. Results:The resulting prognostic model comprised three genes: MTMR11, VANGL1, and CD46. This gene panel was significantly associated with the prognosis of cervical cancer patients receiving radiotherapy and showed acceptable predictive performance across multiple cancer types. qRT-PCR analysis revealed that the expression patterns of MTMR11 and VANGL1 were generally consistent with radioresistance of cervical cancer, whereas CD46 exhibited an unexpected expression trend. Conclusions:Our findings indicate that MTMR11, VANGL1, and CD46 are associated with radioresistance and prognosis in cervical cancer. Their potential clinical utility, especially in predicting radiotherapy response at the individual patient level, requires further validation in larger, independent, and prospective cohorts.
