Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China.
Eur J Cancer. 2012 Oct;48(15):2353-60. doi: 10.1016/j.ejca.2012.03.015. Epub 2012 Apr 13.
Neoadjuvant chemotherapy (NACT) for cervical cancer still remains controversial. NACT was evaluated to establish selection criteria.
A matched-case comparison was designed for the NACT group (n=707) and primary surgery treatment (PST; n=707) group to investigate short-term responses and high/intermediate risk factors (HRFs/IRFs). The 5-year disease-free survival (DFS) and overall survival (OS) rates were stratified by NACT response, HRFs/IRFs, International Federation of Gynecology and Obstetrics (FIGO) stage and tumour size, respectively.
The clinical and pathological response rates were 79.3% and 14.9% in the NACT group. In comparison to the PST group, IRFs but not HRFs were significantly decreased (P<0.05), and the 5-year DFS rate was significantly improved in the NACT group (88.4% versus 83.1%, P=0.021). Moreover, the 5-year DFS and OS rates were favourably increased in the clinical responders in comparison to the PST group and the clinical non-responders (P<0.05). Compared to those of clinical non-responders, the 5-year DFS and OS rates of clinical responders, with or without HRFs, were also significantly increased (P<0.01). In stage IB2, the 5-year DFS and OS rates were significantly increased, whereas operation duration declined in the NACT group (P<0.05). For patients with stage IB tumours of 2-5 cm, the 5-year DFS and OS rates of clinical responders were significantly improved (P<0.05).
NACT is a suitable option for patients with cervical cancer, especially for NACT responders and patients with stage IB, which provides a new concept of fertility preservation for young patients.
宫颈癌新辅助化疗（NACT）仍存在争议。本研究旨在评估 NACT 的效果，以建立选择标准。
设计了 NACT 组（n=707）和直接手术治疗（PST；n=707）组的匹配病例对照研究，以调查短期反应和高/中风险因素（HRFs/IRFs）。根据 NACT 反应、HRFs/IRFs、国际妇产科联合会（FIGO）分期和肿瘤大小，对 5 年无病生存率（DFS）和总生存率（OS）进行分层。
NACT 组的临床和病理反应率分别为 79.3%和 14.9%。与 PST 组相比，IRFs 而非 HRFs 显著降低（P<0.05），NACT 组的 5 年 DFS 率显著提高（88.4%对 83.1%，P=0.021）。此外，与 PST 组和临床无反应者相比，临床反应者的 5 年 DFS 率显著提高（P<0.05）。与临床无反应者相比，临床反应者（无论有无 HRFs）的 5 年 DFS 和 OS 率也显著提高（P<0.01）。对于 IB2 期患者，NACT 组的 5 年 DFS 和 OS 率显著提高，而手术时间缩短（P<0.05）。对于 2-5cm 期 IB 肿瘤患者，临床反应者的 5 年 DFS 和 OS 率显著提高（P<0.05）。
NACT 是宫颈癌患者的一种合适选择，特别是对 NACT 反应者和 IB 期患者，为年轻患者提供了保留生育能力的新观念。
