Abstract
The role of pathological response in long-term outcome is still unclear in cervical cancer patients treated with neoadjuvant chemotherapy (NACT) in China. This study aimed to investigate the effect of optimal pathologic response (OPR) on survival in the patients treated with NACT and radical hysterectomy. First, 853 patients with stage IB2-IIB cervical cancer were included in a retrospective analysis; a Cox proportional hazards model was used to investigate the relationship between pathological response and disease-free survival (DFS). In the retrospective database, 64 (7.5%) patients were found to have achieved an OPR (residual disease <3 mm stromal invasion); in the multivariate Cox model, the risk of death was much greater in the non-OPR group than in the OPR group (HR, 2.61; 95%CI, 1.06 to 6.45; P = 0.037). Next, the role of OPR was also evaluated in a prospective cohort of 603 patients with cervical cancer. In the prospective cohort, 56 (9.3%) patients were found to have achieved an OPR; the log-rank tests showed that the risk of recurrence was higher in the non-OPR patients than in the OPR group (P = 0.05). After combined analysis, OPR in cervical cancer was found to be an independent prognostic factor for DFS.
Highlights
optimal pathological response (OPR) developing areas, such as in rural areas of China, doctors have to resort to neo-adjuvant chemotherapy to shrink tumours for surgical performance[6,7,8,9,10,11]
Previous studies in western areas have concluded that an optimal pathological response (OPR) may be a prognostic factor for survival in cervical cancer[12,24]
We designed a retrospective study to assess whether pathological response affected survival in Chinese patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB2-IIB cervical cancer treated with neo-adjuvant chemotherapy and radical hysterectomy; we validated the effect of pathological response in a prospective cohort
Summary
OPR developing areas, such as in rural areas of China, doctors have to resort to neo-adjuvant chemotherapy to shrink tumours for surgical performance[6,7,8,9,10,11]. NACT provides an opportunity to optimize therapy, especially for fertility-preserving therapy[19,20]. This favourable result of NACT may lead to a new era of LACC treatment. Few studies have examined the impact of OPR on survival in Chinese patients, and no studies have performed such an assessment with a sufficiently large sample size to draw a definitive conclusion. We designed a retrospective study to assess whether pathological response affected survival in Chinese patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB2-IIB cervical cancer treated with neo-adjuvant chemotherapy and radical hysterectomy; we validated the effect of pathological response in a prospective cohort
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