Prognostic Analysis of Local Advanced Cervical Cancer After Neoadjuvant Chemotherapy

Abstract

Background: This study aims to analyze the factors influencing the survival and prognosis of patients with locally advanced cervical cancer (LACC) after neoadjuvant chemotherapy (NACT), so as to provide theoretical guidance for clinical work. Methods: A total of 263 patients diagnosed with stage IB3, IIA2, IIB and IIIC1r cervical cancer according to FIGO 2018 criteria were enrolled in this retrospective study. They were admitted to First Affiliated Hospital of Chongqing Medical University from January 2018 to December 2021. After receiving 1-4 cycles of "platinum + paclitaxel" chemotherapy and effective NACT, the patients accepted surgery including radical hysterectomy and pelvic lymph node dissection. All patients with one of high-risk factors or two of medium-risk factors are exposed to additional radiation according to post-operative pathological risk factors. Patients were divided into two parts based on whether or not radiotherapy was supplemented after surgery. The baseline characteristics, treatment plan, pathological characteristics and survival prognosis of the two groups were compared in this study. The main endpoint of the study was recurrence or death within 2 years. The 2-year progression-free survival (PFS) rate was compared between the two groups in order to analyze the risk factors affecting prognosis. Results: In this study, 59 patients without supplemental radiotherapy and 204 patients with supplemental radiotherapy were included. The 2-year PFS rate was 98.10% and 98.90% respectively (p=0.606) in the group with and without supplementary radiotherapy. Univariate analysis showed that parastatal infiltration and lympho-vascular space infiltration were risk factors for 2-year PFS, while multivariate analysis showed that only lympho-vascular space infiltration was independent risk factor for PFS. Conclusion: In conclusion, NACT can also reduce the occurrence of radiotherapy in addition to obtaining the opportunity of surgery, so as to improve the quality of life of patients without affecting survival. Meanwhile, LVSI is an independent risk factor for progression-free survival in patients with locally advanced cervical cancer who receive NACT. For such patients, complementary treatment after surgery is more helpful to ensure prognosis.