Efficacy Of Concurrent Chemoradiation Followed By Surgery Versus Concurrent Chemoradiation For The Treatment Of Locally Advanced Cervical Cancer: A Meta-analysis

Background: Among female malignant tumors,the incidence of cervical cancer is in the second place.Cervical cancer is a serious threat to women’s health.In developping countries, the largest proportion of patients died of cancer consists of people with cervical cancer. Concurrent chemoradiation therapy(CCRT) is considered to be the standard management for locally advanced cervical cancer(LACC) in many countries. Nevertheless,the role of additional surgery following CCRT is still controversial.This is a meta-analysis comparing the efficacy of concurrent chemoradiation followed by surgery and concurrent chemoradiation for the treatment of locally advanced cervical cancer.Objective: We want to compare the effects of concurrent chemoradiation therapy followed by hysterectomy with concurrent chemoradiation therapy alone for the treatment of locally advanced cervical cancer by the method of meta-analysis.Method: To find the accepting papers,we searched the database of P ub Med、Medline、Embase,The Cochrane Library,Wan fang database and C hina National Knowledge Infrastructure.Articles were evaluated with inclusion criterion、exclusion criterion and principles of systematic evaluation introduced by the Cochrane collaboration. The included papers are in English and C hinese,which we can get the full text of literature.The extracted data are analysed with Revman 5.3.The heterogeneity among studies is estimated with Odds Ratio and 95% confidence interval. We use fixed effects model when P > 0.10. Otherwise,we use the random effects model. If I2 ≤50%,we can accept its heterogeneity.Results: Six articals were included.Five of them were in English and one in Chinese.One of the articals was of randomized controlled trial and others were of control studies. The outcome of the meta-analysis: CCRT followed by surgery versus CCRT for the treatment of locally advanced cervical cancer, there was statistical significant improvment in three-year overall survival(OS)(OR=1.52, 95%CI[1.10~2.09], P=0.01) 、 five- year OS(OR=1.91, 95%CI[1.36 ~ 2.69], P=0.0002) 、 five- year progression free survival(OR=2.27, 95%CI[1.62~3.17], P=0.00001); There were no significant statistical differences in three-year progression free survival(OR=1.54, 95%CI[0.82~2.86], P=0.18) or loco-regional recurrence rate(O R=0.54, 95%CI [0.21~1.38], P=0.20);It showed statistical significant decrease in overall recurrence rate(O R=0.55, 95%CI[0.39~0.78], P=0.0007).Conclusion: The outcome of this meta-analysis is in favour of the therapy of CCRT followed by surgery, including improving three- year OS、five-year OS、five- year progression free survival,reducing overall recurrence rate. But it should be noted that we still need more high-quality meta-analysis clinical studies to confirm this conclution for the performance bias and selection bias in the limited studies.