Abstract
BACKGROUND: Concurrent chemoradiation therapy (CCRT) is the standard treatment for patients with locally advanced cervical cancer (LACC), including those with parametrial or lymphatic metastasis. However, therapeutic outcomes vary, and prognostic factors remain inadequately defined. METHODS: We conducted a retrospective study involving 128 patients with cervical cancer who received definitive CCRT between 2003 and 2022 at Seoul National University Bundang Hospital. We evaluated clinicopathological variables, including age, height, body weight, histologic type, tumor size, human papillomavirus (HPV) type, squamous cell carcinoma (SCC) antigen levels, and involvement of the parametrium, lower vagina, and lymph nodes. Survival outcomes were analyzed using Kaplan-Meier curves and Cox proportional hazards models. RESULTS: Stage IIIC1r, according to the 2018 FIGO staging system, was the most common disease stage among the study population. Para-aortic lymph node metastasis was significantly associated with increased recurrence risk (odds ratio [OR] = 5.892; 95% confidence interval [CI]: 2.030-17.097; p = 0.001) and was linked to poorer progression-free survival (PFS, p = 0.001), overall survival (OS, p = 0.014), and treatment-free interval (TFI, p = 0.001). Obesity (body mass index ≥ 25 kg/m(2)) was also associated with higher recurrence risk (OR = 2.737; 95% CI: 1.093-6.855; p = 0.032) and reduced PFS (p = 0.0089). CONCLUSIONS: Para-aortic lymph node metastasis and obesity are significant prognostic factors in patients undergoing definitive CCRT for LACC. These findings highlight the need for risk-adapted treatment strategies and potential incorporation of adjunctive therapies to improve clinical outcomes in high-risk patient subgroups.