Abstract
ObjectiveTo compare the efficacy and safety of neoadjuvant chemotherapy followed by surgery (NACTS) and primary surgery (PS) in locally advanced cervical cancer (LACC).MethodsLACC (stage IB2/IIA2, FIGO 2009) patients who accepted NACTS or PS in the Cancer Hospital of the Chinese Academy of Medical Sciences from 2007 to 2017 were enrolled, and a database was established. A 1:1 ratio propensity score matching (PSM) was performed for the NACTS group and PS group according to pretreatment characteristics. After PSM, the clinicopathological features and prognosis between the matched groups were compared.ResultsOf 802 cases in the database, 639 met the inclusion criteria, with 428 received paclitaxel plus platinum NACTS, and 211 received PS. After PSM, the two groups had comparable pretreatment characteristics, with 190 cases in each group. In the NACTS group, the operation parameters were similar to the PS group except for the longer operation time (median 255 min vs. 239 min, P = 0.007); pathological intermediate-risk factors including tumor diameter (P < 0.001) and LVSI(+) (P < 0.001) were significantly decreased; fewer patients were with ≥2 intermediate-risk factors (10.5 vs. 53.2%, P < 0.001) so that the rate of adjuvant radiotherapy was reduced (54.2 vs. 70.0%, P = 0.002). DFS and OS were similar between the NACTS group and PS group (P > 0.05). However, for patients with tumor diameter ≥5 cm or SCC ≥5 ng/ml, DFS of the NACTS group was significantly prolonged (P = 0.016, P = 0.007).ConclusionPaclitaxel plus platinum neoadjuvant chemotherapy can reduce adjuvant radiotherapy by decreasing pathological risk factors. Patients with tumor diameter ≥5 cm or SCC ≥5 ng/ml may obtain survival benefits.
Highlights
Cervical cancer is the fourth most common malignant tumor in women, with approximately 570,000 new cases and 310,000 deaths worldwide in 2018 [1]
Compared with the primary surgery (PS) group, the NACTS group was with larger tumor, higher SCC value, more advanced stage, and a higher proportion of squamous cell carcinoma
TP/TC regimen is with high response and rare adverse reaction, which is superior to other regimens for neoadjuvant chemotherapy
Summary
Cervical cancer is the fourth most common malignant tumor in women, with approximately 570,000 new cases and 310,000 deaths worldwide in 2018 [1]. Advanced cervical cancer (LACC) refers to patients of International Federation of Gynecology and Obstetrics (FIGO) stage IB2/IIA2. The survival of those patients is not satisfactory [2], and the treatment remains non-uniform: the National Cancer Network (NCCN) guidelines suggest concurrent chemoradiotherapy as the standard choice for LACC (category 1), and primary surgery is an alternative (category 2B) [3]. Many medical centers perform primary surgery for LACC patients in Europe and Asia; especially 60% of Japanese medical centers perform primary surgery as reported [4]. Given the bulky tumor of LACC, conducting primary surgery is usually difficult. Adjuvant therapy is often needed due to multiple pathologic risk factors that exist in LACC [5, 6]
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