Analysis Of Neoadjuvant Chemotherapy And Prognostic Factors Affecting The Outcome Of Stage Ⅰ B-Ⅱ B Cervical Cancer Treated By Radical Hysterectomy And Pelvic Lymphadenectomy

PART 1Effect of neoadjuvant chemotherapy plus radical surgery on survival of patients withⅠB-ⅡB cervical cancerObjectives:The aim of this study was to investigate the effect of neoadjuvant chemotherapy (NACT) on survival of patients who underwent radical surgery and to analysis the relationships between response to NACT and risk factors.Methods:From January 02 to December 08,3896 patients with stage IB/IIB or stageⅡB cervical carcinoma were reviewed,1018 receiving NACT (the NACT group) and 2538 undergoing radical surgery (the surgery/control group). Matched case-control comparison was used in this study,707 patients received NACT while 707 patients were treated with PST directly. The clinical and pathological responses, lymph node metastasis, parametrial involvement, toxicity,3-year disease-free survival (DFS) and overall survival (OS), and the relation between responses to NACT and long-term survival were investigated.Results:The percentage of stageⅡB and the mean tumor size were no significant for the NACT group than the surgery group. Clinical objective response (CR+PR) was recorded in 584 patients (82.6%),85 CRs and 499 PRs.33 with pathological complete response,22 with carcinoma in situ, and 50 with stroma infiltrated 1-3mm. Incidence of deep stromal invasion and LVSI in NACT group were lower than that in the control arm in stageⅠB1-ⅡA (p<0.05, p<0.05), and also did it in stageⅡB. In FIGO stageⅠB-ⅡB, the 5-year DFS and OS in NACT group were higher than those in surgery group. According to clinical and pathological responses, we divided all patients in NACT group into three subgroups:high/intermediate/poor response subgroups, we found out that better clinical/pathological responses were favorably associated with both disease-free survival and overall survival.Conclusion:NACT improved long-term DFS and OS of patients with stage IB/IIA or stageⅡB cervical carcinoma. Better responses to NACT were associated with more survival benefits.IntroductionCervical cancer is the second most common malignancy in women in developing countries, although there was a shift worldwide during the previous decade becouse of the successful screening and vaccine. Nowadays, more than 85% of these cases and deaths occur in developing countries [1-3].Although numerous data from retrospective studies were available, the national practice standards of NACT for cervical cancer have not been systemically reviewed either in the developed countries or in China. The Chinese Gynecological Oncology Study (GOS) has conducted a national survey to measure the treatment, process and outcome for patients with cervical cancer since 1999 in China, and the Chinese GOS working group initiated a nationwide survey of cervical cancer.Especially, for the patients with the International Federation of Gynecology and Obstetrics (FIGO) stageⅠB-ⅡB cervical cancer, the primary standard treatment of early-stage disease consists of radical hysterectomy and pelvic or para-aortic lymphadenectomy. Patients treated with surgery prior to RT were also eligible for the Chinese GOS survey. Therefore, we were able to collect the data regarding surgically treated patients with cervical cancer.However, in China radical surgery associated with or without neoadjuvant chemotherapy (NACT) was the major treatment modality in stageⅠB-ⅡA bulky and part of stageⅡB patients. NACT plus radical surgery treatment might offer an alternative to the Clinical Characteristics of 44 patients with Recurrent Cervical CancerAbstract Objective:Clinical features and treatment of recurrent cervical cancer were explored in the study. Methods:This study population consisted of a consecutive series of patients,which were treated from January 2001 to December 2007. Clinical information (clinical symptoms,pathological characteristics) of 44 cases of recurrent cervical cancer was retrospectively analyzed. Results:The recurrence of single site accounted for 68.2% (30/44), and the recurrence of multi-site accounted for 31.8%(14/30). The median time of relapse of FIGO stageⅠA～ⅡA was 12 months, and the median time of recurrence of FIGO stageⅡB～Ⅳwas 8.5 months. Conclusions:The common relapse site of cervical cancer was pelvic cavity. The prognosis of relapse cervical cancer was poor. It was necessary to detect lesion as early as possible in order to improve survival by comprehensive treatment.