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Survival outcomes of neoadjuvant chemotherapy-related strategies compared with concurrent chemoradiotherapy for locally advanced cervical cancer: a meta-analysis of randomized controlled trials

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The survival benefits of neoadjuvant chemotherapy (NAC) compared with those of concurrent chemoradiotherapy (CRT) for locally advanced cervical cancer (LACC) patients remain uncertain. Meta-analysis was used to compare NAC and CRT.

Methods

A systematic search was performed up to 9 September 2020. Survival outcomes were analyzed based on event frequency or hazard ratios (HRs). Multilevel mixed-effects logistic regression was applied to analyze the effect of regimen variables on survival outcomes.

Results

Analysis based on Cox regression showed that CRT was better than NAC + radical hysterectomy (RT) (HR 1.25; 95% confidence interval (CI)) 1.02–1.54; p = 0.034) in terms of overall survival (OS). According to multilevel mixed-effects model analysis comparing NAC + RT and CRT, LACC patients who used cisplatin instead of carboplatin had a better Progression-free survival (PFS) (odds ratio (OR) 1.54; 95% CI 1.08–2.20; p = 0.016). When NAC + CRT and CRT were compared, gemcitabine administration was associated with a decrease in PFS (OR 0.47; 95% CI 0.22–0.99; p = 0.047). Increased doses of cisplatin and paclitaxel were associated with survival improvement.

Conclusion

Based on traditional meta-analysis, CRT was better than NAC + RT in terms of OS. Carboplatin instead of cisplatin as part of the NAC + RT strategy or gemcitabine use in NAC + CRT may not be a good choice. An increased total dosage of paclitaxel and/or cisplatin as part of NAC + CRT and CRT strategies may improve the survival outcome of LACC patients.

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Availability of data and materials

All data generated or analyzed during this study are included in this published article and its additional files.

References

  1. Cohen PA, Jhingran A, Oaknin A et al (2019) Cervical cancer. Lancet 393:169–182

    Article  Google Scholar 

  2. Grant BD, Quang T, Possati-Resende JC et al (2019) A mobile-phone based high-resolution microendoscope to image cervical precancer. PLoS ONE 14:e0211045

    Article  CAS  Google Scholar 

  3. Rose PG, Java J, Whitney CW et al (2015) Nomograms predicting progression-free survival, overall survival, and pelvic recurrence in locally advanced cervical cancer developed from an analysis of identifiable prognostic factors in patients from NRG Oncology/Gynecologic Oncology Group Randomized Trials of Chemoradiotherapy. J Clin Oncol 33:2136–2142

    Article  Google Scholar 

  4. Minig L, Patrono MG, Romero N et al (2014) Different strategies of treatment for uterine cervical carcinoma stage IB2-IIB. World J Clin Oncol 5:86–92

    Article  Google Scholar 

  5. Rottenberg S, Disler C, Perego P (2020) The rediscovery of platinum-based cancer therapy. Nat Rev Cancer. https://doi.org/10.1038/s41568-020-00308-y

    Article  PubMed  Google Scholar 

  6. Jiang B, Ni H, Zhou Z et al (2020) Parkin enhances sensitivity of paclitaxel to NPC by arresting cell cycle. Pathol Res Pract 216:152755

    Article  CAS  Google Scholar 

  7. Zhu Y, Yang J, Zhang X et al (2018) Acquired treatment response from neoadjuvant chemotherapy predicts a favorable prognosis for local advanced cervical cancer: a meta-analysis. Medicine 97:e0530

    Article  Google Scholar 

  8. Iwata T, Miyauchi A, Suga Y et al (2016) Neoadjuvant chemotherapy for locally advanced cervical cancer. Chin J Cancer Res 28:235–240

    Article  CAS  Google Scholar 

  9. de la Torre M (2018) Neoadjuvant chemotherapy in woman with early or locally advanced cervical cancer. Rep Pract Oncol Radiother 23:528–532

    Article  Google Scholar 

  10. Datta NR, Stutz E, Gomez S et al (2019) Efficacy and safety evaluation of the various therapeutic options in locally advanced cervix cancer: a systematic review and network meta-analysis of randomized clinical trials. Int J Radiat Oncol Biol Phys 103:411–437

    Article  CAS  Google Scholar 

  11. de Azevedo CR, Thuler LC, de Mello MJ et al (2016) Neoadjuvant chemotherapy followed by chemoradiation in cervical carcinoma: a review. Int J Gynecol Cancer 26:729–736

    Article  Google Scholar 

  12. Zou W, Han Y, Zhang Y et al (2019) Neoadjuvant chemotherapy plus surgery versus concurrent chemoradiotherapy in stage IB2-IIB cervical cancer: A systematic review and meta-analysis. PLoS ONE 14:e0225264

    Article  CAS  Google Scholar 

  13. Zeng X, Zhang Y, Kwong JS et al (2015) The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid Based Med 8:2–10

    Article  Google Scholar 

  14. Liu Z, Rich B, Hanley JA (2014) Recovering the raw data behind a non-parametric survival curve. Syst Rev 3:151

    Article  Google Scholar 

  15. Fu Z, Liska D, Talan D et al (2017) Cranberry reduces the risk of urinary tract infection recurrence in otherwise healthy women: a systematic review and meta-analysis. J Nutr 147:2282–2288

    Article  CAS  Google Scholar 

  16. Shim S, Yoon BH, Shin IS et al (2017) Network meta-analysis: application and practice using Stata. Epidemiol Health 39:e2017047

    Article  Google Scholar 

  17. StataCorp. (2015) Stata Statistical Software: Release 14. StataCorp LP, College Station, TX

    Google Scholar 

  18. The Cochrane Collaboration. 2014. Review Manager 5 (RevMan 5): Release 5.3. The Nordic Cochrane Centre, Copenhagen: the Cochrane Collaboration.

  19. R Foundation for Statistical Computing. 2017. R: A language and environment for statistical computing: Relsease 3.6.1. R Foundation for Statistical Computing, Vienna, Austria: R Foundation for Statistical Computing.

  20. Kenter G, Greggi S, Vergote I et al 2019 Results from neoadjuvant chemotherapy followed by surgery compared to chemoradiation for stage Ib2-IIb cervical cancer, EORTC 55994 J Clin Oncol https://doi.org/https://doi.org/10.1200/JCO.2019.37.15_suppl.5503

    Article  Google Scholar 

  21. da Costa SCS, Bonadio RC, Gabrielli FCG et al (2019) Neoadjuvant chemotherapy with cisplatin and gemcitabine followed by chemoradiation versus chemoradiation for locally advanced cervical cancer: a randomized phase II trial. J Clin Oncol 37:3124–3131

    Article  Google Scholar 

  22. Shanmugam S, Govindasamy G, Hussain SA et al (2019) Comparison of neoadjuvant chemotherapy followed by radical hysterectomy and neoadjuvant chemoradiation followed by radical hysterectomy with concurrent chemoradiation in locally advanced carcinoma cervix (FIGO Stages IB2, IIA2, IIB): interim results of a randomized control study. J SAFOG 11:35–43

    Article  Google Scholar 

  23. Gupta S, Maheshwari A, Parab P et al (2018) Neoadjuvant chemotherapy followed by radical surgery versus concomitant chemotherapy and radiotherapy in patients with stage IB2, IIA, or IIB squamous cervical cancer: a randomized controlled trial. J Clin Oncol 36:1548–1555

    Article  CAS  Google Scholar 

  24. Tian XY, Li RG, Liu DY, Zeng YB (2017) Neoadjuvant chemotherapy and concurrent chemoradiotherapy for 48 patients with locally advanced cervical cancer. J Guangdong Med College 35:312–314

    Google Scholar 

  25. Zhao MY (2016) Comparison of the clinical efficacy of concurrent chemoradiotherapy and preoperative neoadjuvant chemotherapy in the treatment of locally advanced cervical cancer. World Latest Med Inf 16:85–86

    Google Scholar 

  26. Tang J, Tang Y, Yang J et al (2012) Chemoradiation and adjuvant chemotherapy in advanced cervical adenocarcinoma. Gynecol Oncol 125:297–302

    Article  Google Scholar 

  27. Drokow EK, Zi L, Qian H et al (2020) Tolerability, efficacy and feasibility of concurrent gemcitabine and cisplatin (CGP) combined with intensity modulated radiotherapy for loco-regionally advanced carcinoma of the cervix. J Cancer 11:2632–2638

    Article  CAS  Google Scholar 

  28. Kitagawa R, Katsumata N, Shibata T et al (2015) Paclitaxel plus carboplatin versus paclitaxel plus cisplatin in metastatic or recurrent cervical cancer: The open-label randomized phase III trial JCOG0505. J Clin Oncol 33:2129–2135

    Article  CAS  Google Scholar 

  29. Gadducci A, Cosio S (2020) Neoadjuvant chemotherapy in locally advanced cervical cancer: review of the literature and perspectives of clinical research. Anticancer Res 40:4819–4828

    Article  CAS  Google Scholar 

  30. Tian XP, Qian D, He LR et al (2014) The telomere/telomerase binding factor PinX1 regulates paclitaxel sensitivity depending on spindle assembly checkpoint in human cervical squamous cell carcinomas. Cancer Lett 353:104–114

    Article  CAS  Google Scholar 

  31. Marita A, Ordeanu C, Rancea A et al (2018) Long-term survival following neoadjuvant chemotherapy and concomitant radiochemotherapy in locally advanced cervical cancer: results of the Oncology Institute “Prof. Dr. Ion Chiricuta” experience. J Med Life 11:42–50

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiac Surgery, First Hospital, Jilin University, Changchun, 130021, People’s Republic of China

    Baogang Wang

  2. Department of Echocardiography, First Hospital, Jilin University, Changchun, 130021, People’s Republic of China

    Yuying Tan

  3. Department of Geriatrics, First Hospital, Jilin University, Changchun, 130021, People’s Republic of China

    Xiaolin Yang

  4. Department of Oncological Gynecology, First Hospital, Jilin University, No. 1, Xinmin Street, Changchun, 130021, People’s Republic of China

    Xiaxia Man

Authors
  1. Baogang Wang
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  2. Yuying Tan
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  4. Xiaxia Man
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Contributions

Baogang Wang: project development, data collection, and manuscript writing; Yuying Tan: data collection and data analysis. Xiaolin Yang: data analysis. Xiaxia Man: project development and manuscript editing.

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Correspondence to Xiaxia Man.

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The authors declare that they have no competing interests.

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The manuscript does not contain new clinical studies or new patient data. And no ethical approval was necessary due to its exclusive use of secondary data.

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404_2020_5916_MOESM1_ESM.pdf

Supplementary Figure 1. Network comparisons of the strategies included in the analyses. a: PFS based on event frequency; b: OS based on event frequency; c: PFS based on HR; d: OS based on HR. Supplementary Table 1. The network league table for PFS results based on event frequency (OR and its 95%CI).Supplementary Table 2. The network league table for OS results based on event frequency (OR and its 95%CI).Supplementary Table 3. The network league table for PFS results based on the Cox regression results (HR and its 95%CI).Supplementary Table 4. The network league table for OS results based on the Cox regression results (HR and its 95%CI).

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Wang, B., Tan, Y., Yang, X. et al. Survival outcomes of neoadjuvant chemotherapy-related strategies compared with concurrent chemoradiotherapy for locally advanced cervical cancer: a meta-analysis of randomized controlled trials. Arch Gynecol Obstet 304, 485–493 (2021). https://doi.org/10.1007/s00404-020-05916-5

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  • DOI: https://doi.org/10.1007/s00404-020-05916-5

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