The Effect of Neoadjuvant Chemotherapy on Lymph Node Metastasis of FIGO Stage IB1-IIB Cervical Cancer: A Systematic Review and Meta-Analysis

Abstract

Objectives: This study aimed to assess the effect of neoadjuvant chemotherapy (NACT) on the rate of lymph node metastasis (LNM) in FIGO stage IB1-IIB cervical cancer patients and compare the LNM between NACT plus surgery and surgery only. Methods: We identified 34 eligible studies in PubMed, Web of Science, Cochrane Library, and EMBASE from inception to July 27, 2019. Data analyses were performed by Stata (version 13) and Revman (version 5.3). Results: In these 34 included studies, the pooled incidence of LNM was estimated as 23% (95% CI, 0.20-0.26; I 2 = 79.6%, P<0.001). In the subgroup analysis, we identified five factors, including study type, year of publication, continents from which patients came, histological type and the FIGO stage. When taking FIGO stage into consideration, the LNM rate was 13% in stage IB (95% CI: 0.10-0.15; I 2 = 5.5%, P=0.385), 23% in stage IIA (95% CI: 0.18-0.28; I 2 = 0%, P=0.622), and 27% in stage IIB (95% CI: 0.20-0.33; I 2 = 0%, P=0.898), respectively. Through the comparison between NACT plus surgery and surgery only based on the six randomized controlled trials, the incidence of positive lymph nodes was lower in patients receiving NACT plus surgery than surgery only (RR=0.57, 95% CI: 0.39-0.83; I 2 = 60.5%, P=0.027). The 5-year OS was higher in the NACT + surgery group than surgery-only group (RR=1.13, 95% CI: 1.03-1.23; I 2 = 0.0%, P=0.842). Conclusions: Among cervical cancer in stage IB1-IIB, the preoperative NACT plus radical surgery resulted in a 23% probability of LNM, which was lower than those receiving radical surgery only. In stage IIA and IIB, the effect of NACT to reduce LNM was more obvious.

Pretreatment Radiologically Enlarged Lymph Nodes as a Significant Prognostic Factor in Clinical Stage IIB Cervical Cancer: Evidence from a Taiwanese Tertiary Care Center in Reaching Consensus

“…Recent literature has indicated that the rate of regional LN metastasis is approximately 16-36% for stage IIB CC [25]. Previous studies have also demonstrated a lower rate of LN metastasis in stage IIB CC compared to the present study, ranging from 25.8-30% [26][27][28][29][30]. The frequency of regional LN metastasis in stage IIB CC reported in previous studies is presented in Table 4.…”

Treatment Strategies and Prognostic Factors of 2018 FIGO Stage IIIC Cervical Cancer: A Review

“…NACT plus surgery, which could reduce LNM and even achieve longer 5-year DFS and OS, may represent a new therapeutic option for stage IIIC cervical cancer. 37 , 38 A systematic review and meta-analysis showed that in stages IB1 to IIB, preoperative NACT plus radical surgery resulted in a 23% probability of LNM, which was lower than those receiving radical surgery only. In stages IIA and IIB, the effect of NACT on reducing LNM was more obvious.…”

“…In stages IIA and IIB, the effect of NACT on reducing LNM was more obvious. 38 Another review reported the efficacy of NACT in the treatment of locally advanced cervical cancer, which showed that NACT reduced LNM and the tumor diameter in patients before surgery and the No. of high-risk patients who required postoperative radiation therapy.…”

Neoadjuvant chemotherapy with paclitaxel and carboplatin followed by definitive chemoradiation in locally advanced cervical carcinoma. Experience of a cancer hospital in Pakistan

“…NACT offers a theoretical advantage of tumor downstaging and eradicating micrometasis which could lead to improved progression free and overall survival but till date efficacy and safety of NACT remains debatable and there is lack of agreement worldwide on this approach. Although a metanalysis showed that neoadjuvant chemotherapy plays a role in downstaging the primary tumor and reduce the chance of lymph node and distant metastasis in patients with stage IB1 to IIA cervical cancer [21]. On the contrary no significant benefit of NACT was observed in other studies [22,23].…”