| Objective:The purpose of this study was to investigate the response of patients with locally advanced cervical cancer to neoadjuvant chemotherapy and its related influencing factors,and to analyze whether the treatment mode of neoadjuvant chemotherapy combined with radical surgery can improve the long-term survival of patients with locally advanced cervical cancer.Methods:We retrospectively collected IB2 and IIA2 patients(according to FIGO 2009)who were treated in the Department of Gynecology,Affiliated Hospital of Qingdao University from September 2006 to may 2015.There were 194 patients with locally advanced cervical cancer,131 patients with neoadjuvant chemotherapy combined with radical surgery(NACT + RS)and 63 patients with direct radical surgery(PRS).NACT + RS group received platinum based 1-3 cycles of combined chemotherapy,and radical surgery was performed within 21 days after the completion of chemotherapy;PRS group received direct radical surgery for cervical cancer.The two groups of patients with postoperative pathological results showed poor tumor differentiation,invasion of lymph nodes and para uterine tissue,invasion of cervical deep myometrium or lymph vessel metastasis and other high-risk factors,were given additional chemotherapy or radiotherapy and other adjuvant treatment.Objective to analyze the efficacy of neoadjuvant chemotherapy(NACT)and its influencing factors;to compare the high-risk pathological factors,additional adjuvant treatment,3-year,5-year overall survival(OS)and progress-free survival(PFS)of NACT + RS group and PRS group;and to further analyze the effect of chemotherapy efficacy on OS and PFS.Results:1.The general data characteristics of two groups :compared with PRS group,the clinical stage of NACT + RS group was later,and there was no significant difference in other clinical features,so they can be grouped.2.The high-risk pathological factors showed that the average operation time of NACT + RS group and PRS group were 243.37 ± 64.413 min and 234.79 ± 50.782 min,respectively,and the average blood loss was 592.37 ± 276.892 ml and 580.95 ± 246.333 ml,respectively.The positive rate of vaginal resection margin and the deep interstitial infiltration rate of the NACT+RS group were significantly lower than that of the PRS group(P=0.040;P=0.015)).There was no statistically significant difference between the two groups of patients in lymph node metastasis,invasion of parauterine tissues and lymphatic vessels.3.Postoperative adjuvant treatment of the two groups of patients: the PRS group had a higher postoperative adjuvant treatment rate than the NACT+RS group,but there was no statistical significance(65.08% vs.52.67%,P>0.05);taking into account the different effectiveness of patients with chemotherapy,the new treatment.The effectiveness of adjuvant chemotherapy was stratified analysis of patients in the NACT+RS group.The results showed that the postoperative additional treatment rate of patients with effective neoadjuvant chemotherapy was significantly lower than that of patients with ineffective neoadjuvant chemotherapy(34.48% vs.88.64% P=0.000).4.The short-term efficacy of neoadjuvant chemotherapy and its influencing factors:the overall response rate of NACT was 66.41%,in which the response rate of neoadjuvant chemotherapy in patients with pathological type of squamous cell carcinoma(69.91%)was significantly higher than that in patients with non squamous cell carcinoma(44.44%),(P= 0.034).The effective rate of chemotherapy in patients with poor tissue differentiation(79.49%)is higher than that in patients with high and middle differentiation(60.87%),(P=0.039);the effective rate of chemotherapy in patients with positive lymphatic metastasis(51.43%)was lower than that in patients with negative(71.88%),(P =0.028);the effective rate of chemotherapy in patients with positive deep interstitial infiltration(55.74%)was significantly lower than that in patients with negative interstitial infiltration(75.71%),(P=0.016);the effective rate of chemotherapy in the patients with TP Chemotherapy was the highest(78.95%,P = 0.045).Age,FIGO stage,tumor diameter,route of chemotherapy administration,parametrial metastasis and lymphatic vessel metastasis had no significant correlation with the response rate of neoadjuvant chemotherapy.Logistic multivariate analysis showed that pathological type was the most significant factor among the factors influencing the effect of chemotherapy,that is,patients with squamous cell carcinoma had the best effect of chemotherapy.(OR=3.80,95%CI:1.250--11.570,P<0.05).5.The survival prognosis of the two groups of patients: the 5-year OS and PFS of the NACT+RS and PRS groups were(87.6% vs.78.7%,P=0.036)and(86.1% vs.76.3%,P=0.167),respectively.According to the further grouping of chemotherapy effectiveness,the 5-year OS of the NACT+RS chemotherapy effective group,the ineffective group and the PRS group were 93.0%,77.3%,and 78.7%,respectively.The 5-year overall survival rate in the effective group was significantly higher than that in the ineffective group(P =0.001)and PRS group(P = 0.001).The 5-year PFS rates of the three groups were 93%,72.7% and 76.3%,respectively.The PFS of the chemotherapy effective group was higher than that of the ineffective group(P=0.001)and the PRS group(P=0.007),which was statistically significant.Conclusion:1.The effectiveness of neoadjuvant chemotherapy is affected by the pathological type,degree of tissue differentiation,lymph node metastasis,interstitial infiltration and chemotherapy scheme.The effectiveness of chemotherapy is the highest in patients with squamous cell carcinoma,which is an independent factor affecting the efficacy of chemotherapy.2.The 5-year overall survival rate of patients can be improved with neoadjuvant chemotherapy,which has no significant effect on the progress-free survival;but patients who are effective to chemotherapy can significantly improve the overall survival rate and tumor-free survival rate. |
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