Objective: To assess the efficacy of platinum-based neoadjuvant chemotherapy (NACT) in patients with locally advanced cervical cancer (LACC) and investigate the pretreatment predictors of the response.
Patients and Methods: A total of 219 patients with International Federation of Gynecology and Obstetrics (FIGO 2009) stage IB2-IIA2 LACC who received platinum-based NACT from December 2007 to December 2017 were reviewed, and their clinical-pathological characteristics and follow-up data were retrospectively collected and analyzed. The baseline characteristics of age, FIGO stage, histology, tumor differentiation, tumor size, and clinical outcomes, including post-operative pathological risk factors, overall survival (OS), and progression-free survival (PFS) were compared between the responders and non-responders.
Results: The overall response rate was 58.9% (129/219), and 19 (8.7%) patients achieved pathologically complete remission. NACT responders showed significantly better OS and PFS than non-responders (P_OS= 0.002, P_PFS= 0.002). The response to NACT was identified as an independent risk factor for OS (hazard ratio [HR] = 2.453, 95% confidence intervals [95% CI], 1.125– 5.348, P = 0.024) and PFS (HR = 2.196, 95% CI, 1.183– 4.076, P = 0.013), and patients with IB2/IIA1 and a tumor size of < 5 cm tended to receive better response than patients with IIA2 (P = 0.004) and a tumor size of ≥ 5 cm (P = 0.027).
Conclusion: The response rate of platinum-based NACT was approximately 60%. The response to NACT was an independent risk factor for prognosis, and patients with earlier stage and smaller tumor tended to respond better to NACT.
Keywords: locally advanced cervical cancer, neoadjuvant chemotherapy, clinical response, predictor, prognosis