Objective: to assess the efficacy of neoadjuvant chemotherapy and the prognostic factors in patients with locally advanced cervical cancer.
Methods: from January 2005 to December 2006, 139 patients with stage Ib - IIa bulky cervical cancer (tumor diameter ≥ 4 cm) treated at our department were enrolled into this retrospective study. The patients were divided into two groups of neoadjuvant chemotherapy (NAC) (n = 117) and director operation (DOR) (n = 22). In NAC group, 84 with stage Ib and 33 with stage IIa disease received radical hysterectomy and lymphadenectomy after 1 - 3 cycles of neoadjuvant chemotherapy. In DOR group, 18 with stage Ib and 4 with stage IIa disease underwent radical hysterectomy directly after diagnosis. The high-risk patients in both groups received chemotherapy and/or radiotherapy according to the post-operative pathological results. All patients were followed up routinely to assess the prognosis.
Results: eighty-four patients achieved complete remission (CR) or partial remission (PR) after NAC administration. And the response rate for NAC was 71.8%. The death risk in PR cases was 28.82 times higher than that in CR cases. None of 12 patients with a pathologically complete remission developed recurrence or death. The median follow-up duration was 50 months for all cases. In NAC group, the disease-free survival time was (55.36 ± 2.16) months and the 3-year survival rate was 82.1%. The recurrent rate was 26.5% while the average recurrent time of (11.06 ± 9.50) months. In DOR group, the above parameters were (61.64 ± 3.63) months, 90.9%, 9.1% and (12.50 ± 7.78) months respectively. There were no significant difference between two groups in these prognosis parameters (all P > 0.05). Univariate analysis revealed that histological grade, deep cervical invasion, response to neoadjuvant chemotherapy and lymph node metastasis were the risk factors for prognosis in patients on NAC. The COX hazard analysis indicated that lymph node metastasis was only independent prognostic factor.
Conclusion: neoadjuvant chemotherapy appears not to offer any advantage of improving the prognosis in locally advanced cervical cancer. The lymph node metastasis is an important prognostic factor. The patients with a pathological complete remission after NAC may have a good prognosis.