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. 2019 Mar 7:12:1881-1891.
doi: 10.2147/OTT.S186451. eCollection 2019.

Neoadjuvant chemotherapy with radical surgery vs radical surgery alone for cervical cancer: a systematic review and meta-analysis

Hui Zhao  1 , Yue He  1 , Shu-Li Yang  1 , Qun Zhao  1 , Yu-Mei Wu  1
Affiliations

Neoadjuvant chemotherapy with radical surgery vs radical surgery alone for cervical cancer: a systematic review and meta-analysis

Hui Zhao et al. Onco Targets Ther. .

Abstract

Aim: This systematic review was designed to evaluate the efficacy of neoadjuvant chemotherapy with radical surgery vs radical surgery alone for cervical cancer.

Methods: A computerized search was done for trials from PubMed, EMBASE, CENTRAL, and Cochrane Database of Systematic Reviews. The trials included neoadjuvant chemotherapy plus radical surgery vs radical surgery alone. We measured overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), local and distant recurrence, lymph node metastasis, and parametrial infiltration per patient.

Results: In all, 13 studies involving 2,158 subjects were included. In regard to OS, DFS, PFS, local and distant recurrence, and parametrial infiltration, neoadjuvant chemotherapy plus radical surgery was similar to radical surgery alone. Among them, subgroup analysis of eight studies involving 1,544 patients with locally advanced cervical cancer (FIGO stage IB2-IIB) showed that neoadjuvant chemotherapy (NACT) plus radical surgery significantly improved OS, and decreased local and distant recurrence rates, lymph node metastasis rate, and the level of parametrial infiltration compared to radical surgery alone.

Conclusion: The present study demonstrates that preoperative NACT is now an accepted effective procedure in selected patients with locally advanced cervical cancer (FIGO stage IB2-IIB). However, the relationship between NACT and longer DFS and PFS cannot be demonstrated by this meta-analysis. Thus, the decision to use or not to use NACT before radical surgery depends on the surgeon's experience and clinical judgment. Nevertheless, further research in this field is urgently needed to confirm it.

Keywords: cervical cancer; meta-analysis; neoadjuvant chemotherapy; surgery.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow diagram of study searching strategy.
Figure 2
Figure 2
Quality assessment summary for included studies.
Figure 3
Figure 3
Methodological quality assessment for each included study. Note: +, low risk of bias; −, high risk of bias; ?, unclear risk of bias.
Figure 4
Figure 4
Comparison of long-term efficacy between NACT plus radical surgery group and the radical surgery alone group. (A) Forest plot of overall survival (OS); (B) forest plot of disease-free survival (DFS); (C) forest plot of progression-free survival (DFS); (D) forest plot of recurrence rate. Abbreviations: M–H, Mantel–Haenszel; NACT, neoadjuvant chemotherapy.
Figure 5
Figure 5
Comparison of pathological findings between the NACT plus radical surgery group and the radical surgery alone group. (A) Forest plot of lymph node metastatic; (B) forest plot of parametrial infiltration. Abbreviations: M–H, Mantel–Haenszel; NACT, neoadjuvant chemotherapy.
Figure 6
Figure 6
Subgroup analyses of long-term efficacy between the NACT plus radical surgery group and the radical surgery alone group. (A) Forest plot of overall survival (OS); (B) forest plot of recurrence rate. Abbreviations: M–H, Mantel–Haenszel; NACT, neoadjuvant chemotherapy.
Figure 7
Figure 7
Subgroup analyses of pathological findings between the NACT plus radical surgery group and the radical surgery alone group. (A) Forest plot of lymph node metastatic; (B) forest plot of parametrial infiltration. Abbreviations: M–H, Mantel–Haenszel; NACT, neoadjuvant chemotherapy.
See this image and copyright information in PMC

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