Comparative Analysis Of Neoadjuvant Chemoradiotherapy Plus Surgery Versus Surgery In Local Advanced Cervical Cancer

ObjectiveTo analyze and compare the efficacy and related adverse reactions of neoadjuvant chemoradiotherapy(NCRT)combined with surgery and surgery alone in patients with stage IB2 and IIA2 locally advanced cervical cancer(LACC),so as to find the most effective and individualized treatment for LACC.MethodsThe clinical data of 255 patients with 2009 International Federation of Gynecology and Obstetrics(FIGO)stage IB2 and IIA2 cervical cancer admitted to Fujian Provincial Cancer Hospital from February 2013 to October 2016 were retrospectively analyzed.They were divided into two groups according to the treatment: 121 patients in the NCRT combined with surgery group and 134 patients in the surgery alone group.The average operation time,average intraoperative blood loss,intraoperative and postoperative complications,postoperative pathology,postoperative adjuvant therapy,adverse reactions and survival after the end of treatment were compared between the two groups and the clinical efficacy of NCRT was evaluated.Results1.The response rate was 85.12% in the NCRT combined with surgery group.The maximum diameter of the tumor in the NCRT combined with surgery group could be reduced by 2.2–6.3cm,with an average reduction of 3.87±1.23 cm,and the difference was statistically significant(P<0.01).2.The differences in the average operation time and average intraoperative blood loss between the two groups had no statistical significance(P>0.05).3.The incidence rate of surgical complications in the two groups was 31.4%and 32.1%,respectively,and the difference had no statistical significance(P>0.05).4.There were no significant differences in postoperative pathological parametrial invasion,positive vaginal stump,meeting Sedlis criteria and four-factor model between the two groups(P>0.05).The postoperative lymphatic metastasis rate was 39.6% and 54.5% in NCRT combined with surgery alone group,and the difference had statistical significance(P<0.05).5.There was no significant difference in serious adverse reactions between the two groups(P>0.05).6.The 3-year overall survival rate was 89.3% and 86.5%,and the 3-year disease-free survival rate was 82.1% and 84.2% in the two groups,respectively,and the differences had no statistical significance(P>0.05).Among them,the3-year overall survival rate of lymph node metastasis in the two groups was 70.3%and 54.5%,respectively,and the 3-year disease-free survival rate was 76.6% and59.2%,respectively,and the differences had statistical significance(P<0.05).Conclusions1.NCRT can effectively reduce the local tumor volume of LACC.2.Compared with surgery alone,NCRT combined with surgery does not increase the difficulty of surgery and the risk of intraoperative and postoperative complications,and the adverse reactions are controllable,but it fails to significantly improve the overall survival(OS)and progression-free survival(PFS)of LACC patients.3.Compared with surgery alone,NCRT can significantly improve PFS and OS in LACC patients with lymph node metastasis,which is worthy of further study.