Neoadjuvant Chemotherapy Followed By Surgery Versus Surgery Alone For Cervical Cancer: A Meta-Analysis

Objective : To assess the efficacy of neoadjuvant chemotherapy followed by surgery in patients with cervical cancer, and to analyze factors influencing the efficacy.Materials and method: A systemic review of neoadjuvant chemotherapy followed by surgery was performed by searching the data bases including PUBMED, MEDLINE, China National Knowledge infrastructure and Wan fang data base. Literature references were checked at the same time. Gynecological carcinoma related magazines in library of Shandong University were searched manually .Languages was restricted to Chinese and English. Trials were collected and evaluated according to the inclusion and exclusion criteria. Data including overall survival, disease-free survival, recurrence, metastasis, and positive pathological findings were extracted from the NACT group and the control group respectively. The similar trials were merged and relative risk was used to express the result for the categorical variable.Results: Eight trials involving 1248 patients were included, Including 3 RCT and 5 CCT. None of them described randomization in detail or the usage of double blinded method. The findings suggest that: (1) There was no obvious difference between the NACT group and the control group in the 3-year overall (RR=1.09,95%CI[0.95,1.26], p=0.22) and disease-free survival ( DFS ) (RR=1.12,95%CI[0.96,1.30],p=0.14);(2) The NACT group acquired more benefit in long-term survival, when the 5-year overall (RR=1.24,95%CI[1.13,1.36],p<0.00001) and disease-free survival (RR=1.25, 95%CI [1.11,1.41],p=0.0002) and longer than 5-year overall survival (RR=1.37, 95%CI [1.20,1.56], p<0.00001) was referred to. (3)NACT reduced the recurrence (RR=0.48, 95%CI[0.63,0.36], p<0.0001) and metastasis rate (RR=0.49,95%CI[0.30,0.80],p=0.04) significantly . (4) The pathological risk factors were decreased significantly when compared to the control group, including parametrical infiltration (RR=0.40, 95%CI [0.17,0.98],p=0.04), vascular space involvement (RR=0.30, 95%CI [0.21,0.49], p<0.0001), lymph node metastasis (RR=0.42, 95%CI[0.31,0.57], p<0.0001). (5) NACT showed obvious efficacy for patients with lesions larger than 4cm in diameter (RR=1.75,95%CI[1.12,2.16],p=0.02), but efficacy for those less than 4cm in diameter (RR=0.79, 95%CI [0.40,1.55], p=0.49).Conclusion: Neoadjuvant chemotherapy followed by surgery can effectively eliminate the pathological risk factors and improve the long-term survival in patients with cervical cancer. The diameter of tumor proved to be an important prognostic factor in patients with cervical cancer.