Neoadjuvant chemotherapy does not improve the prognosis and lymph node metastasis rate of locally advanced cervical squamous cell carcinoma

Yan, Wen; Si, Lihui; Ding, Yaming; Qiu, Shuang; Zhang, Qi; Liu, Linlin

doi:10.1097/md.0000000000017234

Cited by 11 publications

(17 citation statements)

References 22 publications

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“…Gupta et al (25) reported that the clinical response rate was 78.5% with TC neoadjuvant chemotherapy, while Cho et al (10) discovered 83.3% achieved clinical response with TC/TP regimen. Only 0-8.9% severe leukopenia was observed in neoadjuvant chemotherapy with TP regimen (21,26,27). The results of these studies are similar to our study.…”

Section: Discussionsupporting

confidence: 91%

“…A meta-analysis found that NACTS reduced the rate of adjuvant radiotherapy in LACC by reducing a high-risk factor-lymph node metastasis (7). However, there was no difference in the rate of lymph node metastasis between the NACTS group and PS group in our study, which is supported by Yan et al (21) and Hu et al (17), both of whom found that NACTS could not reduce lymph node metastasis. We found that the intermediate-risk factors--bulky tumor and LVSI(+), were significantly decreased in the NACTS group, which is consistent with other studies (10,12,17).…”

Section: Discussionsupporting

confidence: 81%

“…Previous studies have shown that neoadjuvant chemotherapy could improve tumor resectability by reducing the tumor volume, avoid adjuvant radiation by reducing the pathological risk factors (7)(8)(9)(10)(11). But no consensus has been reached on whether NACTS can provide survival benefits (10,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Based on the previous efficacy evaluation, NCCN guidelines suggest paclitaxel plus cisplatin (TP) or paclitaxel plus carboplatin (TC) as the first-line therapy for recurrent and metastatic cervical cancer (3).…”

Section: Introductionmentioning

confidence: 99%

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Paclitaxel Plus Platinum Neoadjuvant Chemotherapy Followed by Surgery Versus Primary Surgery in Locally Advanced Cervical Cancer—A Propensity Score Matching Analysis

Zhang

Wang

et al. 2020

Front. Oncol.

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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.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Paclitaxel Plus Platinum Neoadjuvant Chemotherapy Followed by Surgery Versus Primary Surgery in Locally Advanced Cervical Cancer—A Propensity Score Matching Analysis

Zhang

Wang

et al. 2020

Front. Oncol.

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“…grouped the patients with cervical carcinoma stage IB2 or IIA2 according to whether they received NAC or not before surgery and evaluated the treatment and prognosis of NAC [15]. The results showed that NAC did not significantly affect DFS (P = 0.453) and OS (P =0 .933) between the 2 groups.…”

Section: Acute and Late Toxicitiesmentioning

confidence: 99%

“…Therefore, it has emerged as an alternative option of treatment based on several studies that have shown a significant benefit of NAC+RS over radiotherapy alone or concurrent chemotherapy in terms of overall survival (OS) and disease free survival (DFS) [13,14]. On the other hand, some studies have reported inconsistent findings regarding the outcomes of NAC [15,16].…”

Section: Introductionmentioning

confidence: 99%

Effect of three therapeutic strategies for FIGO stage IB2/IIA2 cervical Cancer

Zhang

Tang²,

Shen

et al. 2020

Preprint

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Background: To evaluate the long-term efficacy and toxicities of three therapeutic strategies for patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB2/IIA2 cervical cancer. Methods : 206 patients with stage IB2/IIA2 cervical cancer were selected in this retrospective study. The patients were classed into three groups according to the primary therapy: primary surgical treatment (PST), neoadjuvant chemotherapy followed by radical surgery (NAC+RS), and concurrent chemoradiotherapy (CCRT). We observed the inter-group differences in patient characteristics, surgery approaches, postoperative rick factors, supplemental therapies and overall survival (OS), disease-free survival (DFS) and acute and late toxicities. Results: Less patients in NAC+RS group had deep cervical stromal invasion than those in PST group (p=0.024). No differences in lymph node metastasis, intravascular tumor embolus, vaginal margin and the need of postoperative supplement treatment were observed between PST and NAC+RS ( P =0.734, P =0.704, P =0.487 and P =0.714, respectively). With a median follow-up time of 57 months, the 3-year DFS and OS in PST, NAC+RS and CCRT were 85.6%, 79.2%, 85.7% and 87.5%, 84.9%, 85.7% ( P =0.424 and P =0.856, respectively). The most frequently observed acute toxicities were hematologic side effects. No significant inter-group differences in leukopenia, neutropenia, thrombocytopenia and anemia were observed (all P >0.05). No patient experienced grade 3-4 hepatotoxicity and nephrotoxic. Late toxicity ≥grade 3 mainly consisted of lower extremity lymphedema (4/104, 3.8%), bowel obstruction (3/104, 2.9%) and thrombosis (1/104, 1.0%) in PST, lower extremity lymphedema (5/53, 9.4%) and bowel obstruction (1/53, 1.9%) in NAC+RS and radiation proctitis (4/49, 8.2%) and femoral head necrosis (1/49, 2.0%) in CCRT. No grade 5 toxicities were observed. There was no significant difference in cumulative late adverse effects rate in the three groups ( P =0.777). The patients in NAC+RS had increased hospitalization cost than that in PST ( P =0.000) and CCRT ( P =0.000) and prolonged hospitalization time than that in PST ( P =0.000) and same as that in CCRT ( P =0.07). Conclusion: Preoperative NAC decreased the incidence of deep cervical stromal invasion but had no effect on other high risk factors and the need of postoperative supplement treatment. No inter-group differences were demonstrated in 3-year DFS and OS and cumulative acute and late adverse effects. NAC+RS would need longer hospitalization time and cost more. Nevertheless, we believe it should be further explored in prospective trials.

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Neoadjuvant chemotherapy increases the 5-year overall survival of patients with resectable cervical cancer: A systematic review and meta-analysis

Zhang

et al. 2021

Taiwanese Journal of Obstetrics and Gynecology

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Neoadjuvant chemotherapy does not improve the prognosis and lymph node metastasis rate of locally advanced cervical squamous cell carcinoma

Cited by 11 publications

References 22 publications

Paclitaxel Plus Platinum Neoadjuvant Chemotherapy Followed by Surgery Versus Primary Surgery in Locally Advanced Cervical Cancer—A Propensity Score Matching Analysis

Paclitaxel Plus Platinum Neoadjuvant Chemotherapy Followed by Surgery Versus Primary Surgery in Locally Advanced Cervical Cancer—A Propensity Score Matching Analysis

Effect of three therapeutic strategies for FIGO stage IB2/IIA2 cervical Cancer

Neoadjuvant chemotherapy increases the 5-year overall survival of patients with resectable cervical cancer: A systematic review and meta-analysis

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