Neoadjuvant chemotherapy efficacy and prognostic factors in 187 cervical cancer patients with IB2 and IIA2 stage.

OBJECTIVES

To investigate the efficacy and prognostic factors for patients receiving neoadjuvant chemotherapy (NACT) before operation in stage IB2 and IIA2 cervical cancer.

METHODS

A total of 187 patients with IB2 and IIA2 cervical cancer who received NACT combined surgery from January 2005 to January 2016 were enrolled. All patients were divided into an effective group (=142) and an ineffective group (=45) according to the chemotherapy efficacy. Clinical characteristics (containing tumor diameter, hematological inflammatory indexes, etc.) before chemotherapy and postoperative pathology between the two groups were compared. Patient survival analysis was performed by Kaplan-Meier method. The methods of univariate and multifactor analysis were used to analyze the relationship between NACT curative effect, postoperative pathological factors, and survival of patients.

RESULTS

The number of patients with tumor diameter less than 5 cm was more in the chemotherapy effective group than that in the ineffective group (=0.015). Three hematological inflammatory indexes (systemic inflammatory response index, neutrophil-lymphocyte ratio, and monocyte-lymphocyte ratio) in the effective group were lower than those in the ineffective group, respectively (<0.05). The rates of pelvic lymph node metastasis and cervical deep myometrial invasion in the effective group were lower than those in the ineffective group (<0.05). The 3-year and 5-year overall survival of NACT patients were 92.6% and 82.9%, respectively. Univariate analysis showed that chemotherapy efficacy, hematological inflammatory indexes, pelvic lymph node metastasis, and cervical deep myometrial invasion were related to the survival of patients (<0.05). Further multivariate analysis demonstrated that pelvic lymph node metastasis was an independent risk factor for survival of patients (<0.001), whereas effective NACT treatment was a protective factor for survival of patients (<0.001).

CONCLUSIONS

Tumor diameter and hematologic inflammation indexes before treatment are the relevant factors for NACT efficacy in patients with IB2 and IIA2 cervical cancer. Chemotherapy efficacy and pelvic lymph node metastasis are prognostic factors for NACT patients.