Analysis of prognostic factors with cervical squamous cell carcinoma after neoadjuvant chemotherapy

Abstract

15060 Background: The purpose of the study was to evaluate retrospectively the clinical effects of neoadjuvant chemotherapy (NAC) given to women with cervical squamous cell carcinoma using the response rates, prognostic parameters, and diagnostic imaging data (CT scan or MRI). Methods: Patients included in the study were 32 women with a mean age of 48.8 ± 10.6 who had stage Ib-IIIb cervical squamous cell carcinoma and was treated initially with platinum-based NAC prior to surgical intervention at our institution between 1994 and 2003. The response rates in these patients were assessed, and a statistical analysis was performed to evaluate the effects of NACT on survival rates and disease recurrence using the following 9 parameters: 1. clinical stage of cancer, 2. lymph node metastasis, 3. blood vessel invasion, 4. parametrial involvement, 5. depth of stromal invasion, 6. tumor diameter, 7. pre- and post-treatment serum levels of the squamous cell carcinoma antigen, 8. age, and 9. rates of response to NAC. CT scan or MRI obtained prior to and after NAC were compared and evaluated for any evidence of lymph node metastasis. Results: Five and 18 patients achieved complete response (CR) and partial response (PR), respectively, with a response rate of 71.8% for these CR and PR patients. A multivariate analysis revealed that lymph node metastasis was the only independent prognostic parameter for survival rates and disease recurrence. In 13 patients in whom lymph node metastasis was found by the was found by the CT scan or MRI prior to NAC, 8 (61.5%) still showed the evidence of metastasis after treatment. Among these, 7 (87.5%) actually had metastatic lymph nodes. In addition, the occurrence of lymph node metastasis was unrelated to rates of response to NAC. Conclusions: The rates of response to NAC dose not predict prognosis in patients with cervical squamous cell carcinoma. The occurrence of lymph node metastasis is unrelated to rates of response to NAC. If metastatic lymph nodes are suspected after NAC, appropriate treatment approaches should be well considered in such patients. No significant financial relationships to disclose.