Therapeutic impact of neoadjuvant chemotherapy on lymph node metastasis in locally advanced cervical cancer

Cervical cancer remains a global health concern. Lymph node (LN) metastasis, especially para-aortic LN (PAN) involvement, is a critical prognostic factor. While neoadjuvant chemotherapy (NAC) followed by radical hysterectomy (RH) is used for locally advanced cervical cancer, its therapeutic effect on LN metastases remains uncertain.

This retrospective study analyzed 110 patients treated with NAC followed by RH. Patients were grouped into nine cIIIC2 cases with PAN metastasis, 81 non-cIIIC2 squamous cell carcinoma (SCC) cases, and 20 non-squamous cell carcinoma (non-SCC) cases. Non-cIIIC2 SCC cases were further divided into four subgroups by LN status: cN1ypN1 (n = 16), cN1ypN0 (n = 24), cN0ypN1 (n = 10), and cN0ypN0 (n = 31). Tumor and LN size changes by NAC and survival outcomes were analyzed.

In cIIIC2 cases, ypPAN-negative patients showed significantly better 5-year progression-free survival (PFS) compared to ypPAN-positive cases (100% vs. 0%, p < 0.0001). Among non-SCC cases, ypN1 patients (n = 9) had poorer outcomes than ypN0 cases (n = 11) (5-year PFS: 25% vs. 90%, p = 0.0005). As for non-cIIIC2 SCC cases, tumor shrinkage rates varied among SCC subgroups: cN0ypN0 (-58.3%), cN1ypN0 (-45.5%), cN1ypN1 (-36.4%), and cN0ypN1 (-29.6%). cN0ypN1 cases also showed distinct recurrence patterns, with 66.7% experiencing distant metastases; however, prognosis did not differ among four LN-related groups.

NAC can significantly improve prognosis in selected cases where LN metastases are eliminated, particularly in PAN and non-SCC pelvic region metastasis cases. However, such cases are rare, emphasizing the need for better candidate selection and enhanced treatment strategies.