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The long-term outcomes of clinical responders to neoadjuvant chemotherapy followed by radical surgery in locally advanced cervical cancer

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Abstract

Objective

To compare the long-term oncological outcome of neoadjuvant chemotherapy before radical surgery (NCRS) and definitive chemoradiotherapy (DR) for stage IB2 and IIA2 cervical squamous cell carcinoma.

Methods

The clinical outcome of 480 patients with stage IB2 and IIA2 cervical cancer (308 clinical responders, 111 clinical non-responders, 61 unclear) who underwent NCRS (and subgroup assessments) were compared with those of 233 patients who underwent DR.

Results

The clinical response rate was 73.5% in the NCRS group. Multivariate COX regression analyses revealed that NCRS was not correlated with the 5-year overall survival (OS) rate (p = 0.067) or disease-free survival (DFS) rate (p = 0.249). In a subgroup of NCRS, the clinical response group was also shown to be a protective independent factor of 5 year OS rate compared to the DR group (aHR, 0.403; 95% CI, 0.209–0.777), but had no correlation with the 5 year DFS rate (p = 0.089). On the other hand, the clinical non-response group had no correlation with the 5 year OS rate (p = 0.780) or DFS rate (p = 0.669).

Conclusion

Clinical responders who underwent NCRS exhibited a better oncological outcome compared to those who underwent DR.

International Clinical Trials Registry Platform Search Port, http://apps.who.int/trialsearch/; CHiCTR1800017778.

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Data availability

The data that support the findings of this study are available from the corresponding author, Chunlin Chen, upon reasonable request.

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Acknowledgements

This work was supported by 37 medical institutions in mainland China. We would like to thank the other 31 medical institutions and their affiliated contributors for providing data (Appendix B).

Funding

This study was supported by the National Science and Technology Support Program of China (2014BAI05B03), the National Natural Science Fund of Guangdong (2015A030311024) and the Science and Technology Plan of Guangzhou (158100075).

Author information

Author notes

  1. Weili Li, Ping Liu, Fangjie He, and Lixin Sun contributed equally to this paper.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China

    Weili Li, Ping Liu, Fangjie He, Lixin Sun, Jinghe Lang & Chunlin Chen

  2. Department of Gynecologic Oncology, Shanxi Provincial Cancer Hospital, Taiyuan, 030013, China

    Lixin Sun & Hongwei Zhao

  3. Department of Gynecology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, China

    Li Wang

  4. Department of Obstetrics and Gynecology, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China

    Jianxin Guo

  5. Department of Obstetrics and Gynecology, Xinqiao Hospital, Army Medical University, Chongqing, 400042, China

    Ying Yang

  6. Department of Epidemiology, College of Public Health, Guangzhou Medical University, Guangzhou, 511436, China

    Xiaonong Bin

  7. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, 100730, China

    Jinghe Lang

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  1. Weili Li
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Contributions

CC had the study concepts and designed the work and revised the manuscript. WL, PL, FH, and LS participated the study design and wrote the manuscript. HZ, LW, JG, and YY performed collected and analyses the data and prepare manuscript. XB and JL performed quality control of data and revised the manuscript. All authors reviewed and approved the final version.

Corresponding author

Correspondence to Chunlin Chen.

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Conflict of interest

All authors declare no conflict of interest.

Ethical approval

The study was conducted in accordance with the ethical principles of the Helsinki Declaration for research on humans. The study was approved by the Institutional Review Board of Nanfang Hospital Affiliated with Southern Medical University (NFEC-2017-135). Since this study involved previously collected human data, the need for informed consent was waived.

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Li, W., Liu, P., He, F. et al. The long-term outcomes of clinical responders to neoadjuvant chemotherapy followed by radical surgery in locally advanced cervical cancer. J Cancer Res Clin Oncol 149, 4867–4876 (2023). https://doi.org/10.1007/s00432-022-04401-7

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