Impact of adjuvant therapy after radical hysterectomy for early-stage cervical cancer on mortality and recurrence: a systematic review and meta-analysis

Background: The role of adjuvant therapy following radical hysterectomy in early-stage cervical cancer remains controversial. Although adjuvant radiotherapy or chemoradiotherapy is frequently administered to reduce recurrence in patients with adverse pathological features, its effect on overall survival and recurrence prevention remains uncertain. This systematic review and meta-analysis aimed to evaluate the impact of adjuvant therapy after radical hysterectomy on recurrence and mortality in patients with early-stage cervical cancer. Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Comprehensive searches of PubMed, Embase, Web of Science, and the Cochrane Library were performed from inception to October 1, 2025. Eligible studies included randomized controlled trials and observational cohorts comparing radical hysterectomy alone with radical hysterectomy plus adjuvant therapy in patients with FIGO stage IA-IIA cervical cancer. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models according to heterogeneity. Publication bias and sensitivity analyses were conducted to ensure result robustness. Results: Eight studies comprising 1, 396 patients were included. Compared with surgery alone, adjuvant therapy did not significantly reduce recurrence risk (RR = 1.51, 95% CI: 0.75-2.28, I² = 76.2%, p < 0.001) or overall mortality (RR = 1.40, 95% CI: 0.55-2.25, I² = 0.0%, p = 0.519). Subgroup analyses stratified by study design, FIGO stage, and adjuvant regimen confirmed the consistency of findings, and sensitivity analyses demonstrated stability of the pooled estimates. No evidence of publication bias was detected. Conclusions: Adjuvant therapy after radical hysterectomy did not significantly improve recurrence or mortality outcomes in early-stage cervical cancer. These findings support a selective, risk-adapted approach to postoperative management, minimizing unnecessary treatment-related toxicity and optimizing individualized care. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD420251265823.