Meta-analysis Of The Clinical Efficacy Of Neoadjuvant Chemotherapy In Patients With Locally Advanced Cervical Cancer

Objective:The clinical efficacy of neoadjuvant chemotherapy combined with concurrent chemoradiotherapy for LACC patients was comprehensively evaluated by Meta analysis to provide certain theoretical basis for the selection of treatment options for locally advanced cervical cancer patients.Methods:Computer retrieved databases: English databases included Pub Med,The Cochrane Library and Embase that was the Cochrane system recommendation databases;Chinese databases included CNKI,Wanfang and weipu,etc,and we were also retrieved the references of included literatures,The time limit of all the database until October 2020.And exclusion criteria,as defined by the screening and eventually into the literature used according to the quality evaluation of the Cochrane quality evaluation,extract into the research of basic data,baseline data,intervention measures and outcome indicators,such as CRR,ORR,OS,PFS,adverse reaction and so on,at all levels to use Rev Man5.4 merge statistical software to analyze data.Results:There are six RCTs were included,A total of 1333 patients were included,and there are 665 patients in the neoadjuvant chemotherapy group and 668 patients in the concurrent chemoradiotherapy.Meta-analysis of 6 literatures showed that:1.The study of neoadjuvant chemotherapy regimens for TP scheme for layered subgroup analysis,prompt that new adjuvant chemotherapy combined chemoradiation chemoradiation alone improved the patients 1year,3 years OS and 3 years PFS,1 year OS(OR = 22.75,95% CI: 4.32 ～ 119.6,P = 0.0002),3 years OS[OR = 2.61,95% CI: 1.97 ～ 3.45,P < 0.00001],3 years PFS(OR = 2.05,95% CI: 1.57 ～ 2.68,P <0.00001).2.The stratified subgroup analysis of the studies in which the neoadjuvant chemotherapy regimen was TP regimen and the doses were "T 175mg/m2 and P 50mg/m2" indicated that the combination of neoadjuvant chemotherapy and concurrent chemoradiotherapy improved the complete response rate(CRR)of patients compared with concurrent chemoradiotherapy alone,CRR[OR=6.78,95%CI: 4.3 ～ 10.68,P <0.00001].However,the objective response rates of the two groups were similar,ORR [OR=0.62,95%CI:0.33 ～ 1.18,P=0.15].3.In terms of toxic reactions:(1)the incidence of nausea and vomiting was similar between the two groups,with mild nausea and vomiting [OR=0.90,95%CI: 0.70-1.17,P=0.45] and severe nausea and vomiting[OR=1.19,95%CI: 0.90-1.58,P=0.23].(2)Neoadjuvant chemotherapy combined with concurrent chemoradiotherapy group was more likely to have severe myelosuppression,severe myelosuppression[OR=2.92,95%CI: 2.16-3.94,P < 0.00001],while the incidence of mild myelosuppression was similar between the two groups,mild myelosuppression[OR=1.13,95%CI: 0.63-2.05,P=0.68].(3)The incidence of mild anemia was similar between the two groups,mild anemia [OR = 0.86,95% CI: 0.67 ～ 1.10,P = 0.23),but the study of neoadjuvant chemotherapy regimens for TP scheme for layered subgroup analysis,prompt new adjuvant chemotherapy combined concurrent chemoradiation increases the incidence of severe anemia,severe anemia(OR = 3.18,95% CI: 2.28 ～ 4.44,P < 0.00001).(4)The incidence of severe diarrhea was similar between the NACT combined with CCRT and CCRT group,severe diarrhea [OR=1.25,95%CI:0.92-1.70,P=0.16],however,the incidence of mild diarrhea was lower in the combination of neoadjuvant chemotherapy and concurrent chemoradiotherapy than in the concurrent chemoradiotherapy alone group,mild diarrhea [OR=0.64,95%CI: 0.49-0.83,P=0.001].(5)The incidence of radiation cystitis was similar between the two groups,mild radiation cystitis [OR=0.86,95%CI: 0.53 ～ 1.38,P=0.52] and severe radiation cystitis [OR=1.33,95%CI: 0.46 ～ 3.86,P=0.60].Conclusion:For the locally advanced cervical cancer,NACT with TP regimen before CCRT can improve the OS,PFS and CRR of patients,and for the adverse reaction,neoadjuvant chemotherapy combined concurrent chemoradiation increased in patients with severe myelosuppressionand severe anemia,but the incidence of mild diarrhea was low,two groups of the rate of nausea,vomiting,mild bone marrow suppression,mild anaemia,severe diarrhea rate and radioactive cystitis was similar.It indicates that for the LACC patients,it is beneficial to use TP regimen of NACT combined with CCRT,but we should pay attention to the prevention and treatment of severe myelosuppression and severe anemia.