Neoadjuvant chemotherapy for patients with international federation of gynecology and obstetrics stages IB3 and IIA2 cervical cancer: a multicenter prospective trial

作者全名："Hu, Yingjie; Han, Yingyan; Shen, Yuanming; Chen, Jing; Chen, Yaheng; Chen, Yile; Tang, Junying; Xue, Min; Hong, Li; Cheng, Wenjun; Wang, Danbo; Liang, Zhiqing; Wang, Yifeng; Zhang, Qinghua; Xing, Hui; Zhang, Yu; Yi, Cunjian; Yu, Zhiying; Chen, Youguo; Cui, Manhua; Ma, Cailing; Yang, Hongying; Li, Ruizhen; Long, Ping; Zhao, Yu; Qu, Pengpeng; Tao, Guangshi; Yang, Lihua; Wu, Sufang; Liu, Zhihua; Yang, Ping; Lv, Weiguo; Xie, Xing; Ma, Ding; Wang, Hui; Li, Kezhen"

作者地址："[Hu, Yingjie; Han, Yingyan; Chen, Jing; Ma, Ding; Li, Kezhen] Huazhong Univ Sci & Technol, Tongji Hosp, Tongji Med Coll, Dept Gynecol & Obstet, Wuhan, Hubei, Peoples R China; [Shen, Yuanming; Lv, Weiguo; Xie, Xing; Wang, Hui] Zhejiang Univ, Womens Hosp, Sch Med, Dept Gynecol Oncol, Hangzhou, Zhejiang, Peoples R China; [Chen, Yile] Cent South Univ, Hunan Canc Hosp, Affiliated Canc Hosp, Dept Gynecol Oncol,Xiangya Sch Med, Changsha, Hunan, Peoples R China; [Tang, Junying] Chongqing Med Univ, Dept Gynecol, First Affiliated Hosp, Chongqing, Peoples R China; [Xue, Min] Cent South Univ, Dept Gynecol & Obstet, Xiangya Hosp 3, Changsha, Hunan, Peoples R China; [Hong, Li] Wuhan Univ, Dept Obstet & Gynaecol, Renmin Hosp, Wuhan, Hubei, Peoples R China; [Cheng, Wenjun] Nanjing Med Univ, Dept Gynecol, Affiliated Hosp 1, Nanjing, Jiangsu, Peoples R China; [Wang, Danbo] China Med Univ, Liaoning Canc Hosp & Inst, Dept Gynecol, Canc Hosp, Shenyang, Liaoning, Peoples R China; [Liang, Zhiqing] Army Med Univ, Mil Med Univ 3, Southwest Hosp, Dept Obstet & Gynecol, Chongqing, Peoples R China; [Wang, Yifeng] Southern Med Univ, Zhujiang Hosp, Obstet & Gynecol Ctr, Dept Gynecol, Guangzhou, Guangdong, Peoples R China; [Zhang, Qinghua] Huazhong Univ Sci & Technol, Cent Hosp Wuhan, Tongji Med Coll, Dept Obstet & Gynecol, Wuhan, Hubei, Peoples R China; [Xing, Hui] Hubei Univ Arts & Sci, Xiangyang Cent Hosp, Dept Obstet & Gynaecol, Affiliated Hosp, Xiangyang, Hubei, Peoples R China; [Zhang, Yu] Cent South Univ, Xiangya Hosp, Dept Gynecol, Dept Obstet & Gynecol, Changsha, Hunan, Peoples R China; [Yi, Cunjian] Yangtze Univ, Dept Obstet & Gynecol, Affiliated Hosp 1, Jingzhou, Hubei, Peoples R China; [Yu, Zhiying] Shenzhen Univ, Shenzhen Peoples Hosp 2, Hlth Sci Ctr, Dept Gynecol,Affiliated Hosp 1, Shenzhen, Guangdong, Peoples R China; [Chen, Youguo] Soochow Univ, Dept Obstet & Gynecol, Affiliated Hosp 1, Suzhou, Jiangsu, Peoples R China; [Cui, Manhua] Jilin Univ, Dept Gynecol & Obstet, Hosp 2, Changchun, Jilin, Peoples R China; [Ma, Cailing] Xinjiang Med Univ, Dept Gynecol, Affiliated Hosp 1, Urumqi, Xinjiang, Peoples R China; [Yang, Hongying] Kunming Med Univ, Yunnan Tumor Hosp, Dept Gynecol, Kunming, Yunnan, Peoples R China; [Yang, Hongying] Kunming Med Univ, Affiliated Hosp 3, Kunming, Yunnan, Peoples R China; [Li, Ruizhen] Beijing Univ, Dept Gynecol & Obstet, Shenzhen Hosp, Shenzhen, Guangdong, Peoples R China; [Long, Ping] Second Peoples Hosp Jingmen, Jingmen, Hubei, Peoples R China; [Zhao, Yu] Wenzhou Med Univ, Dept Obstet & Gynecol, Affiliated Hosp 2, Wenzhou, Zhejiang, Peoples R China; [Qu, Pengpeng] Tianjin Cent Hosp Gynecol & Obstet, Dept Gynecol Oncol, Tianjin, Peoples R China; [Tao, Guangshi] Cent South Univ, Dept Obstet & Gynecol, Xiangya Hosp 2, Changsha, Hunan, Peoples R China"

通信作者："Li, KZ (通讯作者)，Huazhong Univ Sci & Technol, Tongji Hosp, Tongji Med Coll, Dept Gynecol & Obstet, Wuhan, Hubei, Peoples R China.; Wang, H (通讯作者)，Zhejiang Univ, Womens Hosp, Sch Med, Dept Gynecol Oncol, Hangzhou, Zhejiang, Peoples R China."

来源：BMC CANCER

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000898753200001

JCR分区：Q2

影响因子：3.8

年份：2022

卷号：22

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：Cervical cancer; Neoadjuvant chemotherapy; Radical surgery; Prognosis; Non-responders

摘要："Background: Preoperative neoadjuvant chemotherapy (NACT) has been widely used in developing countries for the treatment of patients with International Federation of Gynecology and Obstetrics (FIGO) stages IB3 and IIA2 cervical cancer. However, the effectiveness of NACT and treatment options for NACT-insensitive patients have been concerning. This study will assess prognostic differences between NACT and primary surgery treatment (PST), determine factors associated with prognosis, and explore better adjuvant treatment modalities for NACT-insensitive patients. Methods: This study analyzed clinical characteristics, pathological characteristics, treatment options, and follow-up information of 774 patients with FIGO stages IB3 and IIA2 cervical cancer from 28 centers from January 2016 to October 2019 who participated in a multicenter, prospective, randomized controlled trial. Results: For patients undergoing NACT, the 5-year OS and PFS rate was 85.8 and 80.5% respectively. They were similar in the PST group. There was no significant difference in OS and PFS between clinical response (CR)/partial response (PR) groups and stable disease (SD)/progressive disease (PD) groups. Apart from deep cervical invasion (p = 0.046) affecting OS for patients undergoing NACT, no other clinical and pathological factors were associated with OS. 97.8% of NACT-insensitive patients opted for surgery. If these patients did not have intermediate- or high-risk factors, whether they had undergone postoperative adjuvant therapy was irrelevant to their prognosis, whereas for patients with intermediate- or high-risk factors, adjuvant chemotherapy resulted in better PFS (chemotherapy vs. no therapy, p < 0.001; chemotherapy vs. radiotherapy, p = 0.019) and OS (chemotherapy vs. no therapy, p < 0.001; chemotherapy vs. radiotherapy, p = 0.002). Conclusions: NACT could be a choice for patients with FIGO stages IB3 and IIA2 cervical cancer. The main risk factor influencing prognosis in the NACT group is deep cervical invasion. After systematic treatment, insensitivity to NACT does not indicate a poorer prognosis. For NACT-insensitive patients, Chinese prefer surgery. Postoperative adjuvant therapy in patients with no intermediate- or high-risk factors does not improve prognosis, and chemotherapy in patients with intermediate- and high-risk factors is more effective than radiation therapy and other treatments."

基金机构："National Key Technology Research and Developmental Program of China; Clinical Medical Research Center for Obstetrical and Gynecological Diseases [2022YFC2704400, 2022YFC2704403]; National Key Technology R&D Program of China [2015BAI13B05]; Health and Family Planning Commission of Hubei Province [2019YFC1005200, 2019YFC1005202]; Research Projects of Tongji Hospital [WJ2019M127]; [2022B02]"

基金资助正文："This work was supported by the National Key Technology Research and Developmental Program of China (2022YFC2704400; 2022YFC2704403), Clinical Medical Research Center for Obstetrical and Gynecological Diseases (2015BAI13B05), the National Key Technology R&D Program of China (2019YFC1005200, 2019YFC1005202), Health and Family Planning Commission of Hubei Province (WJ2019M127), and Research Projects of Tongji Hospital (2022B02)."