Comparison of pathological outcomes of neoadjuvant chemotherapy before surgery versus radical hysterectomy alone in stage IB3 and IIA2 cervical cancer

Abstract

As an alternative treatment strategy, the efficacy of neoadjuvant chemotherapy (NAC) for patients with stage IB3 and IIA2 cervical carcinoma remains uncertain. To address this limitation, this evaluates the pathological outcomes of patients with locally advanced cervical cancer (LACC) treated with NAC before surgery compared with those who underwent radical hysterectomy (RH) alone. A total of 592 patients with stage IB3 and IIA2 cervical cancer were eligible for this study. They were divided into a NAC group (NAC before surgery, n = 259) and a RH group (radical hysterectomy alone, n = 333). Propensity score matching (PSM) was used to eliminate confounding intergroup factors, leading to 233 cases being finally included in the two groups. Patients in the NAC group received 1–3 cycles of nedaplatin plus paclitaxel/docetaxel/irinotecan regimens, followed by surgery 3–5 weeks post-NAC. Patients in the RH group underwent radical hysterectomy after the diagnosis of cervical cancer. Intermediate-risk factors (i.e., lymphovascular space invasion and deep stromal infiltration) and high-risk factors (i.e., lymph node metastasis, positive parametria and positive surgical margin) for the recurrence of LACC were compared between the two groups before and after PSM. The results showed no significant difference in high-risk factors between the NAC and RH groups before and after PSM (p > 0.05). In regard to intermediate-risk factors, a significant difference was observed before PSM in inter-group analysis (lymphovascular space invasion, p = 0.028; deep stromal infiltration, p = 0.011). After PSM, only deep stromal infiltration remained significant, with a decreased incidence observed in the NAC group (p = 0.004). In conclusion, NAC before surgery had minimal impact on high-risk factors and lymphovascular space invasion compared to the RH group. However, we did observe a decrease in deep one-third stromal invasion. These results may be relevant to the decision-making process for postoperative radiotherapy.