Prognostic value of responsiveness of neoadjuvant chemotherapy before surgery for patients with stage IB2/IIA2 cervical cancer

Li, Rui; Lu, Shentao; Si, Jing-ge; Liu, Bin; Wang, Hui; Mei, Yao-yu; Linghu, Hua

doi:10.1016/j.ygyno.2012.11.006

Cited by 33 publications

(28 citation statements)

References 13 publications

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“…Meanwhile, as NACT has been used in the treatment of cervical cancer for many years, previous studies have also revealed that short-term response is an indicator of long-term survival. Scholars (Xiong and colleagues) in Sun Yat-Sen University demonstrated that non-responders had relatively lower survival rates than responders [21]; others (Li and colleagues at Chongqing Medical University; Chen and colleagues at Wuhan University) also made the similar discovery [22, 23]. This study also validated other researchers’ findings as well as our previous results [19, 21–24].…”

Section: Discussionsupporting

confidence: 89%

“…Li and colleagues discovered that patients without lymph node metastasis also achieved significantly longer survival [22], and Biewenga and colleagues demonstrated that lymph node metastasis led to worse overall survival [25]. Sevin and colleagues also revealed its prognostic effect on long-term survival [26]; Kamura and colleagues demonstrated that the presence of positive nodes had a negative effect on long-term survival with statistical significance [27]; and Lai and colleagues discovered that patients with positive nodes also achieved significantly shorter survival periods” [28].…”

Section: Discussionmentioning

confidence: 99%

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Early response to neoadjuvant chemotherapy can help predict long-term survival in patients with cervical cancer

Huang

Zhang

et al. 2016

Oncotarget

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It is still controversial whether cervical cancer patients with clinical responses after neoadjuvant chemotherapy (NACT) have a better long-term survival or not. This study was designed to investigate the effect of the clinical response on the disease-free survival (DFS) of cervical cancer patients undergoing NACT. A total of 853 patients from a retrospective study were used to evaluate whether the clinical response was an indicator for the long-term response, and 493 patients from a prospective cohort study were used for further evaluation. The survival difference was detected by log-rank test, univariate and multivariate Cox regression and a pooled analysis. The log-rank test revealed that compared with non-responders, the DFS of responders was significantly higher in the retrospective data (P = 0.007). Univariate Cox regression showed that the clinical response was an indicator of long-term survival in the retrospective study (HR 1.83, 95% CI 1.18-2.85, P = 0.007). In a multivariate Cox model, the clinical response was still retained as an independent significant prognostic factor in the retrospective study (HR 1.59, 95% CI 1.01-2.50, P = 0.046). The result was also validated in the prospective data with similar results. These findings implied that the clinical response can be regarded as an independent predictor of DFS.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Early response to neoadjuvant chemotherapy can help predict long-term survival in patients with cervical cancer

Huang

Zhang

et al. 2016

Oncotarget

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“…Hu et al (11) reported that the 5-year DFS and OS rates in responders were favorably increased in comparison to those in non-responders and the PST group. A retrospective study suggested that the response to NAC was an independent prognostic factor for prolonged survival in patients with bulky stage IB2/IIA2 cervical cancer (16). Whether the prognosis of NAC-responders is significantly better compared to that of patients receiving primary surgery requires further investigation.…”

Section: A B C Dmentioning

confidence: 99%

Efficacy of neoadjuvant cisplatin and 5-flourouracil prior to surgery in FIGO stage IB2/IIA2 cervical cancer

Liu

Yang

Cao

et al. 2013

Molecular and Clinical Oncology

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Abstract. Cervical cancer is currently the first or second leading cause of cancer-related mortality among women in developing countries. This study was conducted in order to determine whether neoadjuvant cisplatin and 5-flourouracil (NAPF) prior to surgery is superior to primary surgical treatment (PST) as a treatment option for patients with International Federation of Gynaecology and Obstetrics (FIGO) stage IB2̸IIA2 cervical cancer. A retrospective review of 195 patients with early-stage bulky cervical cancer was performed. The patients were divided into two groups, according to whether they received NAPF prior to surgery. The surgical profiles and complications, risk factors of recurrence and survival were compared between the groups. The response rate to NAPF was found to be 61.2%. There were no differences in operative time and intra-operative complications between the two groups, whereas the estimated blood loss in the NAPF and PST groups were 620.1±394.9 and 434.8±233.7 ml, respectively (P=0.000). When compared with PST, NAPF remarkably reduced tumor size (22.5 vs. 93.3%, P=0.000). Furthemore, the ratio of deep stromal invasion was significantly lower in responders to NAPF compared with that in non-responders (46.7 vs. 76.3%, respectively; P= 0.004) and in the PST group (46.7 vs. 70.0%, respectively; P= 0.004). No reduction of high-risk factors (HRFs) was observed. The NAPF group, even the responder subgroup, exhibited no significant improvement in progression-free survival (PFS) and overall survival (OS) compared to the PST group. In conclusion, despite the reduction of intermediate-risk factors (IRFs), neoadjuvant chemotherapy (NAC) with the NAPF regimen prior to radical surgery (RS) did not improve the prognosis in patients with FIGO stage IB2/IIA2 cervical cancer.

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“…Conversely, some patients with minimal lymph node involvement might have cleared the disease with the NACT and could have preserved their fertility potential. Li et al 19 compared 304 patients with stage IB2/IIA2 cervical cancer who either underwent NACT followed by surgery (n = 154) or primary surgery (n = 150), and they noted that the rate of positive nodes in the primary surgery group was 25.6% compared to 8.1% in NACT, suggesting that NACT can ''convert'' node-positive into nodenegative patients. In that study, the response rate (complete/ partial response) to NACTwas 72%.…”

Section: Nact Followed By Fpsmentioning

confidence: 99%

“…Suboptimal response to NACT indicates a partially chemoresistant tumor and seems to be a surrogate indicator of a more aggressive disease. 19 In suboptimal chemoresponders, radical surgery is probably preferable, although it is unclear if that should be a radical trachelectomy or a radical hysterectomy. It is also unclear if adjuvant radiation therapy after trachelectomy should be considered in patients with residual high-risk features in the trachelectomy specimen.…”

Section: How Should Patients With Suboptimal Chemotherapymentioning

confidence: 99%

Bulky Early-Stage Cervical Cancer (2-4 cm Lesions): Upfront Radical Trachelectomy or Neoadjuvant Chemotherapy Followed by Fertility-Preserving Surgery

Plante

2015

Int J Gynecol Cancer

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Radical trachelectomy is now recognized as a valid treatment option for young women with early-stage cervical cancer with lesions measuring less than 2 cm. However, for women with bulky lesions measuring greater than 2 cm, few data are available in the literature to guide management. There are currently 2 options available: either upfront radical trachelectomy or neoadjuvant chemotherapy followed by fertility-preserving surgery. Overall, both options offer very good oncologic outcome; however, the rate of fertility preservation and obstetrical outcome seem superior after neoadjuvant chemotherapy. Advantages and disadvantages of both options are discussed and a thorough literature review is provided. Issues to be further studied are also outlined.

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Prognostic value of responsiveness of neoadjuvant chemotherapy before surgery for patients with stage IB2/IIA2 cervical cancer

Cited by 33 publications

References 13 publications

Early response to neoadjuvant chemotherapy can help predict long-term survival in patients with cervical cancer

Early response to neoadjuvant chemotherapy can help predict long-term survival in patients with cervical cancer

Efficacy of neoadjuvant cisplatin and 5-flourouracil prior to surgery in FIGO stage IB2/IIA2 cervical cancer

Bulky Early-Stage Cervical Cancer (2-4 cm Lesions): Upfront Radical Trachelectomy or Neoadjuvant Chemotherapy Followed by Fertility-Preserving Surgery

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