Pengfei Li1, Ziyu Fang1, Weili Li1, Min Hao2, Wuliang Wang3, Shan Kang4, Jianxin Guo5, Ying Yang6, Yan Ni7, Weidong Zhao8, Anwei Lu9, Bin Ling10, Donglin Li11, Jinghe Lang12, Chunlin Chen13, Ping Liu1. 1. Department of Obstetrics and Gynecology, Nan Fang Hospital, Southern Medical University, Guangzhou, Guangdong, China. 2. Department of Obstetrics and Gynecology, Second Hospital of Shanxi Medical University, Taiyuan, Shangxi, China. 3. Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhengzhou University, Henan, China. 4. Department of Gynecology, Fourth Hospital, Hebei Medical University, Shijiazhuang, China. 5. Department of Obstetrics and Gynecology, Daping Hospital, Army Medical University, Chonqing, China. 6. Department of Obstetrics and Gynecology, Xinqiao Hospital, Army Medical University, Chongqing, China. 7. Department of Obstetrics and Gynecology, Yuncheng Central Hospital, Yuncheng, China. 8. Department of Gynaecology, Anhui Cancer Hospital, HeFei, China. 9. Department of Gynecology, The Maternity and Child Care Hospital of Guizhou Province, Guiyang, China. 10. Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, China. 11. Department of Obstetrics and Gynecology, Guizhou Provincial People's Hospital, Guiyang, China. 12. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China. 13. Department of Obstetrics and Gynecology, Nan Fang Hospital, Southern Medical University, Guangzhou, Guangdong, China. Electronic address: ccl1@smu.edu.cn.
Abstract
OBJECTIVE: To assess the impact of neoadjuvant chemotherapy on postoperative pathology for stage IB2 and IIA2 cervical squamous cell carcinoma. METHODS: Postoperative pathology was compared between patients who received neoadjuvant chemotherapy followed by radical hysterectomy (NACT group) and patients who received upfront radical hysterectomy (URH group). Then, patients in the NACT group were divided into a chemotherapy-sensitive group and a chemotherapy-insensitive group according to their response to chemotherapy. RESULTS: After 1:1 propensity score matching (PSM), the positive rates of lymphovascular space invasion (LVSI) (7.9% vs 17.7%, P = 0.001) and cervical deep stromal invasion (60.4% vs 76.2%, P < 0.001) in the NACT group were significantly lower than those in the URH group, while the positive rates of parametrial invasion, lymph node metastasis, and vaginal margin invasion were not significantly different between the two groups. The rate of positive lymph node metastasis in the chemotherapy-sensitive group was significantly lower than that in the URH group (18.1% vs 26.5%, P = 0.037). CONCLUSION: Among patients with stage IB2 and IIA2 cervical squamous cell carcinomas, NACT can reduce the positive rate of intermediate-risk factors, such as deep cervical stromal invasion and LVSI, but cannot reduce the positive rate of high-risk factors. For patients who are chemotherapy sensitive, NACT can reduce the positive rate of lymph node metastasis.
OBJECTIVE: To assess the impact of neoadjuvant chemotherapy on postoperative pathology for stage IB2 and IIA2 cervical squamous cell carcinoma. METHODS: Postoperative pathology was compared between patients who received neoadjuvant chemotherapy followed by radical hysterectomy (NACT group) and patients who received upfront radical hysterectomy (URH group). Then, patients in the NACT group were divided into a chemotherapy-sensitive group and a chemotherapy-insensitive group according to their response to chemotherapy. RESULTS: After 1:1 propensity score matching (PSM), the positive rates of lymphovascular space invasion (LVSI) (7.9% vs 17.7%, P = 0.001) and cervical deep stromal invasion (60.4% vs 76.2%, P < 0.001) in the NACT group were significantly lower than those in the URH group, while the positive rates of parametrial invasion, lymph node metastasis, and vaginal margin invasion were not significantly different between the two groups. The rate of positive lymph node metastasis in the chemotherapy-sensitive group was significantly lower than that in the URH group (18.1% vs 26.5%, P = 0.037). CONCLUSION: Among patients with stage IB2 and IIA2 cervical squamous cell carcinomas, NACT can reduce the positive rate of intermediate-risk factors, such as deep cervical stromal invasion and LVSI, but cannot reduce the positive rate of high-risk factors. For patients who are chemotherapy sensitive, NACT can reduce the positive rate of lymph node metastasis.