Efficacy Of Neoadjuvant Chemotherapy In Patients With FIGO Stage â… B-â…¡B Cervical Cancer: An Meta-analysis

objective：To compare the effects of neoadjuvant chemotherapy followedby radical surgery with radical surgery for cervical cancer patients stagedIB-IIB by the method of meta-analysis．MaterIAl and Method：Pubmed, Medline, Embase, SciFinder, Cochrane,CNKI were searched for relevant in English and Chinese which werepublished during1990.01～2014.01.We evaluate all the collected articleswith principles and methods of systematic evaluation introduced by theCochrane collaboration．Relevant datas extracted were analysed withRevman5.2．Results：Seven RCTs involving1268patients staged IB-IIB (FIGO) wereincluded，all the RCTs were in English. Results were as follows: inNACT group,there were statistical significant improvment in three-yearOS(RR=1.11，95%Cl(1.04～1.19)， z=3.24， P=0.001<0.05)、 five-yearPFS(RR=1.21，95%Cl(1.08～1.37)，z=3.17，P=0.002<0.05)、more than five-yearOS(RR=1.28，95%Cl(1.11～1.48)，z=3.35，P=0.0008<0.05);there were nostatistical significant differences between NACT group and RS grouppatients in five-year OS(RR=1.09，95%Cl(1.00～1.20)，z=1.91，P=0.06>0.05)、three-year PFS(RR=1.12，95%Cl(0.95～1.33)， z=1.37， P=0.17>0.05)and postoperation adjuvant radiotherapy rate(RR=0.90，95%Cl(0.79～1.03)，z=1.48，P=0.14>0.05),but there statistical significant decrease in overallrecurrence rate(RR=0.54，95%Cl(0.43～0.69)， z=4.92， P<0.00001)、loco-regional recurrence rate （RR=0.54，95%Cl(0.40～0.73)， z=4.01，P<0.0001）、distant metastasis rate(RR=0.63，95%Cl(0.43～0.91)，z=2.45，P=0.01<0.05)、parametrIAl invasion rate(RR=0.52，95%Cl(0.32～0.87)，z=2.51，P=0.01<0.05)、lymph node metastasis rate(R=0.49，95%Cl(0.38～0.64)，z=5.49， P=0.00001<0.05)、 lymphovascular invasion rate(RR=0.58，95%Cl(0.38～0.87)，z=2.61，P=0.009). Furthermore, there was also somedifferences in the effect of neoadjuvant chemotherapy according to tumorsize, cervical cancer stage or chemotherapy response rate.Conclusion: This meta-analysis outcome tends to be in favour ofneoadjuvant chemotherapy, including improving overall survival andprogression-free survival,reducing pelvic recurrence and distantmetastasis and postsurgery dangerously pathologic prognostic factors.Butone point should be noted that， because of the selection bias andmeasure bias in these RCTs，we still need more high-quality RCTs toconfirm this conclution.