Induction chemotherapy prior to definitive chemoradiotherapy in locally advanced cervical cancer patients: A multi-center cohort study

To reappraise the significance of induction chemotherapy (IC) for locally advanced cervical cancer (LACC) patients and to determine which patients might benefit most from IC.

The cumulative survival rates were estimated and compared via Kaplan-Meier method and Log-rank test, respectively. Cox regression analysis was performed to identify risk factors. A risk stratification system was derived from the recursive partitioning analysis (RPA). The induction course per day (ICPD) was defined as the number of IC cycles divided by the interval from IC initiation to radiotherapy start. The optimal cut-off value of ICPD was determined by restricted cubic spline (RCS) analysis.

Three risk subgroups were identified through RPA. Patients with IC had worse 5-yr overall survival (OS) (79.7% VS 89.6%; P = 0.013) and 5-yr progression free survival (PFS) (69.3% VS 81.4%; P = 0.05) than those without IC in low-risk subgroup (stage I/II and squamous cell carcinoma). No significant survival differences were observed between patients receiving IC and those without in middle-risk (stage I/II and adenocarcinoma or adenosquamous) or high-risk subgroup (stage III/IVA) (All P > 0.05). Patients with ICPD > 0.05 had significantly better 5-year OS (80.6% vs. 66.7%; P < 0.001) and 5-year PFS (73.2% vs. 64.1%; P = 0.048) relative to those with ICPD ≤ 0.05. In high-risk subgroup, patients with ICPD > 0.05 achieved superior 5-year OS compared with those without IC (90.0% vs. 71.1%; P < 0.001).

IC might compromise the survival for low-risk LACC patients and should not be routinely recommended for every LACC patients undergoing definitive radiotherapy. High-risk LACC patients treated with IC at ICPD > 0.05 achieved additional survival benefits.