Neoadjuvant chemotherapy for patients with international federation of gynecology and obstetrics stages IB3 and IIA2 cervical cancer: a multicenter prospective trial
Yingjie Hu,
Yingyan Han,
Yuanming Shen,
Jing Chen,
Yaheng Chen,
Yile Chen,
Junying Tang,
Min Xue,
Li Hong,
Wenjun Cheng,
Danbo Wang,
Zhiqing Liang,
Yifeng Wang,
Qinghua Zhang,
Hui Xing,
Yu Zhang,
Cunjian Yi,
Zhiying Yu,
Youguo Chen,
Manhua Cui,
Cailing Ma,
Hongying Yang,
Ruizhen Li,
Ping Long,
Yu Zhao,
Pengpeng Qu,
Guangshi Tao,
Lihua Yang,
Sufang Wu,
Zhihua Liu,
Ping Yang,
Weiguo Lv,
Xing Xie,
Ding Ma,
Hui Wang,
Kezhen Li
Affiliations
Yingjie Hu
Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
Yingyan Han
Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
Yuanming Shen
Department of Gynecologic Oncology, Women’s Hospital, School of Medicine, Zhejiang University
Jing Chen
Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
Yaheng Chen
Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
Yile Chen
Department of Gynecologic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University
Junying Tang
Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University
Min Xue
Department of Gynecology and Obstetrics, The Third Xiangya Hospital of Central South University
Li Hong
Department of Obstetrics and Gynaecology, Renmin Hospital of Wuhan University
Wenjun Cheng
Department of Gynecology, the First Affiliated Hospital of Nanjing Medical University
Danbo Wang
Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute
Zhiqing Liang
Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical University (Third Military Medical University)
Yifeng Wang
Department of Gynecology, Obstetrics and Gynecology Center, Zhujiang Hospital, Southern Medical University
Qinghua Zhang
Department of Obstetrics and Gynecology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology
Hui Xing
Department of Obstetrics and Gynaecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science
Yu Zhang
Department of Gynecology, Xiangya Hospital, Central South University
Cunjian Yi
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University
Zhiying Yu
Department of Gynecology, The First Affiliated Hospital of Shenzhen University, Health Science Center; Shenzhen Second People’s Hospital
Youguo Chen
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University
Manhua Cui
Department of Gynecology and Obstetrics, The Second Hospital of Jilin University
Cailing Ma
Department of Gynecology, the First Affiliated Hospital of Xinjiang Medical University
Hongying Yang
Department of Gynecology, Yunnan Tumor Hospital and The Third Affiliated Hospital of Kunming Medical University
Ruizhen Li
Department of Gynecology and Obstetrics, Shenzhen Hospital of Beijing University
Ping Long
The Second People’s Hospital of Jingmen
Yu Zhao
Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University
Pengpeng Qu
Department of Gynecology Oncology, Tianjin Central Hospital of Gynecology and Obstetrics
Guangshi Tao
Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University
Lihua Yang
Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Kunming Medical University
Sufang Wu
Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
Zhihua Liu
Department of Gynecology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University
Ping Yang
Department of Obstetrics and Gynecology, First Affiliated Hospital, School of Medicine, Shihezi University
Weiguo Lv
Department of Gynecologic Oncology, Women’s Hospital, School of Medicine, Zhejiang University
Xing Xie
Department of Gynecologic Oncology, Women’s Hospital, School of Medicine, Zhejiang University
Ding Ma
Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
Hui Wang
Department of Gynecologic Oncology, Women’s Hospital, School of Medicine, Zhejiang University
Kezhen Li
Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
Abstract Background Preoperative neoadjuvant chemotherapy (NACT) has been widely used in developing countries for the treatment of patients with International Federation of Gynecology and Obstetrics (FIGO) stages IB3 and IIA2 cervical cancer. However, the effectiveness of NACT and treatment options for NACT-insensitive patients have been concerning. This study will assess prognostic differences between NACT and primary surgery treatment (PST), determine factors associated with prognosis, and explore better adjuvant treatment modalities for NACT-insensitive patients. Methods This study analyzed clinical characteristics, pathological characteristics, treatment options, and follow-up information of 774 patients with FIGO stages IB3 and IIA2 cervical cancer from 28 centers from January 2016 to October 2019 who participated in a multicenter, prospective, randomized controlled trial. Results For patients undergoing NACT, the 5-year OS and PFS rate was 85.8 and 80.5% respectively. They were similar in the PST group. There was no significant difference in OS and PFS between clinical response (CR)/partial response (PR) groups and stable disease (SD)/progressive disease (PD) groups. Apart from deep cervical invasion (p = 0.046) affecting OS for patients undergoing NACT, no other clinical and pathological factors were associated with OS. 97.8% of NACT-insensitive patients opted for surgery. If these patients did not have intermediate- or high-risk factors, whether they had undergone postoperative adjuvant therapy was irrelevant to their prognosis, whereas for patients with intermediate- or high-risk factors, adjuvant chemotherapy resulted in better PFS (chemotherapy vs. no therapy, p < 0.001; chemotherapy vs. radiotherapy, p = 0.019) and OS (chemotherapy vs. no therapy, p < 0.001; chemotherapy vs. radiotherapy, p = 0.002). Conclusions NACT could be a choice for patients with FIGO stages IB3 and IIA2 cervical cancer. The main risk factor influencing prognosis in the NACT group is deep cervical invasion. After systematic treatment, insensitivity to NACT does not indicate a poorer prognosis. For NACT-insensitive patients, Chinese prefer surgery. Postoperative adjuvant therapy in patients with no intermediate- or high-risk factors does not improve prognosis, and chemotherapy in patients with intermediate- and high-risk factors is more effective than radiation therapy and other treatments. Trial registration The study was prospectively registered on ClinicalTrials.gov (NCT03308591); date of registration: 12/10/2017.
