Analysis Of Therapeutic Efficacy Of Different Methods For Locally Advanced Cervical Cancer

Study objectives:A retrospective study to analyze the therapeutic effect and its influencing factors of radical surgery(RS),concurrent chemoradiotherapy(CCRT)and neoadjuvant chemotherapy combined with radical surgery(NACT + RS)on locally advanced cervical cancer(LACC),and to provide a reference for the selection of treatment options for patients with locally advanced cervical cancer.Study method:We retrospectively collected 188 patients with primary locally advanced cervical cancer who received treatment in the Affiliated Hospital of Qingdao University from January 1,2013 to December 31,2017 and had clinical stages IB3 and IIA2(FIGO 2018 staging criteria)as the study subjects,including 56 patients who underwent radical surgery directly(including laparoscopy in 12 cases and laparotomy in 44 cases),58 patients who underwent concurrent chemoradiotherapy and 74 patients who underwent neoadjuvant chemotherapy combined with radical surgery(including laparoscopy in 21 cases and laparotomy in 53 cases).A relevant retrospective study was conducted to analyze the clinical characteristics of patients with the three different treatment modalities,compare the patients with the three treatment modalities during and after treatment(compare the surgical situation,postoperative pathology and compare radiotherapy-related complications in the NACT+RS group with the RS group and compare the NACT+RS group with the CCRT group),prognosis,and analyze the factors affecting prognosis.To further analyze the responsiveness to neoadjuvant chemotherapy,prognosis and its influencing factors in the NACT+RS group.Study results:1.General data of patients in the three groups showed that the mean age in the CCRT group(54.74±9.99)was greater than that in the RS group(48.34±9.09)and the NACT+RS group(47.65±7.80);the median lesion diameter(median diameter 5)in the NACT+RS group was greater than that in the RS and CCRT groups;the proportion of stage IIA2 in the CCRT group(79.3%)was higher than that in the RS group(32.1%)and the proportion of stage IIA2 in the NACT+RS group(50.0%).The mean level of SCC at diagnosis was higher in the CCRT group than in the RS and NACT+RS groups,and the differences were statistically significant(P < 0.05).There were no statistically significant differences between the three groups in terms of basic characteristics such as age at marriage,BMI,G,P,marital status,presence of comorbidities,CA125 level,degree of differentiation,and type of pathology(P > 0.05).2.Surgery in the NACT+RS group and the RS group: the mean operative time was228.45±59.76 min and 225.80±44.56 min,respectively,and the incidence of lymphatic cysts was 5.4% and 12.5%,respectively,between the two groups,and the incidence of ureteral injury was 0% and 1.8%,respectively,and the above differences were not statistically significant(p > 0.05).The median intraoperative bleeding volume in the NACT+RS group(300 ml)was more than that in the RS group(200 ml);the transfusion rate(28.4%)was higher than that in the RS group(7.1%);the ureter retention time(8 d)was shorter than that in the RS group(14.5 d),and all of the above differences were statistically significant(p < 0.05).In patients who underwent extensive surgery after neoadjuvant chemotherapy,median intraoperative bleeding was less in the laparoscopic route(200 ml)than in the open route(300 ml),and the difference was statistically significant(P < 0.05).In patients who underwent direct extensive surgery,median bleeding was less in the laparoscopic route(100 ml)than in the open route(200 ml);median ureter retention time was shorter(7 d)than in the open route(21 d),and all differences were statistically significant(P < 0.05).3.postoperative pathology of the NACT+RS group and RS group: the rate of deep interstitial(>1/2)infiltration in the NACT+RS group(13.3%)was significantly lower than that in the RS group(72.7%);the rate of vascular cancer embolism involvement in the NACT+RS group(20.0%)was significantly lower than that in the RS group(59.1%);the rate of follow-up adjuvant therapy in the NACT+RS group(30.0%)was significantly lower than that in the The rate of follow-up adjuvant therapy in the NACT+RS group(30.0%)was significantly lower than that in the RS group(59.1%),and all the above differences were statistically significant(p < 0.05).4.radiotherapy-related complications in the NACT+RS group and the CCRT group:the differences between the two groups were not statistically significant(p > 0.05)between the incidence of complications in alopecia,allergy,constipation,diarrhea,nausea and vomiting,and lower limb thrombosis.the incidence of lymphedema in the NACT+RS group(66.2%)was significantly higher than that in the CCRT group(13.8%),and the differences were statistically significant(p < The incidence of severe myelosuppression in the CCRT group(69.0%)was significantly higher than that in the NACT+RS group(32.4%),and the difference was statistically significant(p < 0.05).5.prognosis and influencing factors of patients with three different treatment modalities:The 3-year progression-free survival(PFS)rates were 64.3%,82.8 and 89.2% in the RS group.The 3-year survival rate(OS)was 71.4%,82.8% and 93.2% in the RS,CCRT and NACT+RS groups.The 5-year progression-free survival(PFS)rates were 64.3%,79.3%and 81.1% in the RS,CCRT and NACT+RS groups.The 5-year survival rates(OS)in the RS group,CCRT group and NACT+RS group were 67.9%,79.3% and 86.5%,all the differences were statistically significant were statistically significant(p < 0.05).The type of pathology and the degree of differentiation may be independent factors influencing the % 3-year PFS in patients with locally advanced cervical cancer(p < 0.05).Treatment type,degree of differentiation may be independent influencing factors for % 3-year OS in patients with locally advanced cervical cancer(p<0.05),and pathology type,degree of differentiation may be independent influencing factors for % 5-year PFS in patients with locally advanced cervical cancer(p<0.05).level of SCC,degree of differentiation may be independent influencing factors for % 5-year OS in patients with locally advanced cervical cancer(p<0.05).6.clinical characteristics and influencing factors of NACT effective group and NACT invalid group: the recent effective rate of neoadjuvant chemotherapy in this study was40.54%.the difference in lesion diameter between NACT effective group and NACT invalid group was statistically significant(p < 0.05).logistic multifactorial analysis showed that lesion diameter was an independent prognostic factor affecting the responsiveness of neoadjuvant chemotherapy.The sensitivity of predicting effective neoadjuvant chemotherapy was highest when the lesion diameter was 4.9 cm in patients with locally advanced cervical cancer,at 84.6%.Study conclusion:In this study,patients with LACC treated with NACT+RS and CCRT had the best prognosis and were the available options..When patients require surgical treatment,neoadjuvant chemotherapy can be administered before radical surgery.If the diameter of the lesion is >5 cm,it is recommended to choose CCRT directly.