Cervical cancer is the fourth most common cancer among women worldwide, with an estimated 604,000 new cases and 342,000 deaths in 2020 [1]. In South Korea, cervical cancer is the seventh most common cancer among women, with 3148 new cases and 967 deaths reported in 2018 [2]. In early-stage cervical cancer, patients with certain pathological factors, such as lymph node metastasis, parametrial invasion, and positive surgical margins, are classified as the high-risk group for recurrence and are indicated for adjuvant therapy (AT) after radical hysterectomy (RH) [3]. For patients without these high-risk factors, the risk criteria were developed in GOG-92 by Sedlis et al. to identify patients who may benefit from radiotherapy after RH, classifying them as the intermediate-risk group; the criteria include specific combinations of tumor size, depth of stromal invasion, and lymphovascular space invasion (LVSI) [4,5].

The risk criteria successfully have identified the difference of unmet needs for AT in early-stage cervical cancer. However, there is limited evidence supporting that these prognostic factors are also valid predictive factors for the effectiveness of the AT. Therefore, some physicians do not strictly adhere to these criteria when determining the need for AT [6,7] and international guidelines do not explicitly specify in the situation when AT should be implemented [[8], [9], [10]]. Furthermore, recent discussions have increasingly challenged the effectiveness of AT in the intermediate-risk group classified by the criteria [11,12]. Therefore, it is meaningful to investigate whether each prognostic factor that constitutes the current criteria can serve as a predictor for the effectiveness of AT.

Hence, we aimed to evaluate whether each prognostic factor traditionally used to assess non-high-risk early-stage cervical cancer could also serve as a predictive factor for the effectiveness of AT.