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Published on: September 12, 2019
Evaluation of neoadjuvant chemotherapy followed by radical hysterectomy in cervical cancer: a single-center study
Akitoshi Yamamura1, Masayo Ukita2, Hiromi Takemura1
1Department of Obstetrics and Gynecology, Shizuoka General Hospital, 4-27-1 Kita Ando, Aoi-Ku, Shizuoka City, Shizuoka, 420-8527, Japan.
Background:
The efficacy of neoadjuvant chemotherapy (NACT) before radical hysterectomy (RH) in cervical cancer remains unclear. We evaluated stage-specific outcomes of NACT-RH at a high-volume center.
Methods:
This retrospective cohort study included patients with non-metastatic cT1b1-2b cervical cancer who underwent RH between 2013 and 2022. For cT1b cases, prognostic outcomes were compared between patients with cT1b3 (any N) who underwent NACT-RH (High-risk, NACT(+)) and those with cT1b1-1b2 N0 who underwent primary RH (Low-risk, NACT(-)), using propensity score matching. For cT2 cases, NACT-RH versus primary RH was compared using inverse probability weighting to adjust for baseline differences.
Results:
Among 191 patients who underwent RH (cT1: n = 99; cT2: n = 92), the matched cT1 cohort comprised 15 High-risk, NACT(+) and 30 Low-risk, NACT(-) patients. Five-year progression-free survival (PFS) was 75.0% (95% confidence interval [CI], 53.4-100.0%) versus 89.9% (95% CI, 79.6-100.0%) (p = 0.427). Overall survival (OS) was 100% in both groups with a median follow-up of > 70 months. In cT2, NACT-RH (n = 73) versus primary RH (n = 19) showed hazard ratios of 2.88 for PFS (95% CI, 0.69-11.97) and 5.64 for OS (95% CI, 0.70-45.35) after baseline adjustment. Among cT2 patients who underwent NACT-RH, PFS and OS were worse in those without an objective response to NACT (n = 18, all cT2b) than in responders.
Conclusion:
NACT-RH was associated with encouraging long-term outcomes in cT1b3, whereas outcomes in cT2 cases remain uncertain, supporting careful selection and response-adapted strategies.