Application of preoperative neoadjuvant chemotherapy in cervical cancer patients undergoing surgical treatment

Objective To explore the clinical effect of preoperative neoadjuvant chemotherapy on locally advanced cervical cancer. Methods From March 2010 to November 2013, 284 cases of stage ⅠB2 and stage ⅡA2 cervical cancer who underwent radical operation in our hospital were divided into experimental group (n=172) and control group (n=112) according to the patients′ will. The experimental group was treated by neoadjuvant chemotherapy (paclitaxel combined with oxaliplatin) before surgery, while the control group was treated by surgery alone. The effect of chemotherapy of experimental group was evaluated, and the operative time, blood loss, adjuvant therapy rates after operation, positive rates of resection margin, pathological characteristics, overall survival (OS) and relapse free survival (RFS) of the two groups were compared. Results The effective rate of neoadjuvant chemotherapy was 76.74% (132/172), while the effective rate in ⅠB2 patients was 82.80% (77/93) and in ⅡA2 patients was 69.62% (55/79), with a statistically significant difference (χ2=4.155, P=0.042). The operation time of experimental group [(231.71±29.04) min] was shorter than that of control group [(253.12±30.97) min, t=5.914, P<0.001]. The adjuvant therapy rate after operation of experimental group was lower than that of control group (61.05% vs. 76.79%, χ2=7.630, P=0.006). There was no significant difference in bleeding volume between the two groups [(614.33±120.19) ml vs. (622.84±131.27) ml, t=0.562, P=0.574], and there were no positive cases of vaginal incision in the two groups. The rates of deep cervical stromal invasion (χ2=6.752, P=0.009), parametrial metastasis (χ2=4.359, P=0.037), vascular infiltration (χ2=5.310, P=0.021), cervical canal involving (χ2=11.022, P<0.001) and lymph node metastasis (χ2=6.830, P=0.009) of experimental group were significantly lower than those of control group. The median follow-up was 31.5 (4.5-42.0) months and 33.4 (4.5-42.0) months in control and experimental group. There were no significant differences in 3-year RFS (52.68% vs. 60.47%, HR=0.746, 95%CI: 0.507-1.067, P=0.109) and 3-year OS (79.46% vs. 81.40%, HR=0.732, 95%CI: 0.436-1.203, P=0.214) between the two groups. Conclusion The pre-operative neoadjuvant chemotherapy is effective for patients with cervical cancer. It can shorten the operation time, improve the pathologic features and decrease the lymph node metastasis rate. But it can not significantly reduce the long-term recurrence rate or improve the long-term survival rate. Key words: Cervical neoplasms; Neoadjuvant chemotherapy; Clinical effect; Survival rate