Comparative Analysis Of Neoadjuvant Chemotherapy Plus Radical Surgery Versus Direct Surgery Or Radiotherapy In Stages ⅠB2 And ⅡA2 Cervical Cancer

Objective:To compare clinical efficacy of three therapies(Neoadjuvant Chemotherapy plus Radical Surgery,Direct Surgery,Radiotherapy)for stages ⅠB2、ⅡA2 cervical cancer.Methods:A retrospective analysis was performed on the clinical date of 182 patients with stages ⅠB2,ⅡA2 cervical cancer who were admitted to The First Affiliated Hospital of GuangXi Medical University from Apr 2010 to Mar 2015.The allocation of patients was based on their previous treatment,Included in the study were 43 patients who were treated with Neoadjuvant Chemotherapy plus Radical Surgery(NACT+RS group),this cases accepted 1-3 cycles of cisplatin based combined chemotherapy before operation,while 96 patients treated with Direct Surgery(DS group),and 43 cases treated with Radiotherapy(RT group).The survival status,postoperative pathology,length of hospital stay,and cost were analyzed statistically.Results:Patients were followed up for 6 to 95 months(median,52 months).The 3-year OS and DFS of 182 patients were 86.3%,84.1%,The 3-year OS rates of the NACT+RS,DS and RT groups were 81.4%,88.5%and 86.0%,respectively,whereas the 3-year DFS rates were 76.7%,86.4%and 86.0%,respectively.Upon comparing the rates of survival among the NACT+RS,DS and RT group,there were no significant differences(OS:P=0.466,DFS:P=0.254).Comparison of postoperative pathology in operation group,deep stromal invasion was significantly less in the NACT+RS group compared to the DS group,were 53.5%,75.0%,respectively(P=0.012),there was no difference in other postoperative pathological factors,including lymphovascular space invasion(P=0.584),positive surgical margin(P=0.587),lymph node metastasis(P=0.620),and the rate of postoperative radiotherapy(P=0.282).There were significantly higher numbers of individuals with hematologic toxicity in the NACT+RS group and RT group than those in the DS group,the thrombocytopenia occurred at a higher rate than in the neoadjuvant chemotherapy plus surgery group,P<0.05.Treatment in both study groups well tolerated.In the three groups,grade 3 to 4 late toxicity was different,but there was no significant difference in cumulative incidence.Compared to the other two groups,the total hospitalization time was extended and the total hospitalization cost significantly increased in the NACT+RS group.There was no statistically significant difference between the DS group and the RT group in total hospital time and cost,P<0.05.Conclusion:Although neoadjuvant chemotherapy can reduce the deep stromal invasion,there is no significant difference in other pathological risk factors.The long-term survival rates and the cumulative incidence of all grade 3 to 4 late toxicity are comparable among Neoadjuvant Chemotherapy plus Radical Surgery,Direct Surgery and Radiotherapy for stages ⅠB2,ⅡA2 cervical cancer.The application of Neoadjuvant Chemotherapy plus Radical Surgery extended the total length of hospital stay and increased the patient’s financial burden,Which should not be a routine choice for treatment of ⅠB2 and ⅡA2.