Neoadjuvant Chemotherapy In Clinical Application Of Cervical Cancer

Part1Comparision of Clinical Efficacy and Outcomes of Multiple Neoadjuvant Treatments for Patients With Stage I B2-IIA Cervical CancerObjective:To evaluate clinical efficacy and survival outcomes of multiple neoadjuvant approaches followed by radical surgery(RS) among patients with cervical cancer stage I B2-IIA。Methods:Between January2009and December2012,a total of111patients with stage I B2-IIA Cervical Cancer were categorized into the following4groups:radical surgery(arm RS),Neoadjuvant intravenous chemotherapy followed by radical surgery (arm IV-NCT),Neoadjuvant intravenous chemotherapy combined with intra-arterial chemotherapy(arm IA+IV-NCT),and Neoadjuvant intravenous chemotherapy combined with vaginal intracavitary irradiation(arm BT+IV-NCT).Two weeks after neoadjuvant treatment,all patients underwent evaluation for response and received radical surgery.Results:With a mean follow-up of37.8months,all patients were evaluable.Baseline characteristics were similarly distributed in the4arms.clinical overall response rates were50%、81.4%、85.0%in the IV-NCT,IA+IV-NCTand BT+IV-NCT groups,respectively.Except for LTD、LVSI,high-risk factors for recurrence did not differ significantly between the four groups.The percentage of patients receiving postoperative adjuvant therapy in IA+IV-NCTand BT+IV-NCT groups was much low than RS groups,but there was no significant difference between IA+IV-NCTand BT+IV-NCT groups.Three-year progression-free survival rates were77.6%、61.8%、77.8%及82.1%in the4groups, respectively(P=0.569).Multivariate analysis showed that only lymph node status correlated with progression-free survival.Conclusions:Although IA+IV-NCTgroup and BT+IV-NCT group may increase the effective rate and the percentage of patients with no postoperative risk factors and decrease the percentage of patients receiving postoperative adjuvant therapy,Neoadjuvant treatment had no significant impact on the outcomes of patients with stages I B2-IIA Cervical Cancer. Part2The association of pre-treatment hematologic markers with response of neoadjuvant theropy,clinical outcome in patients with Ib2-IIb cervical cancerObjective:The aim of this study was to investigated the role of pretreatment hematologic markers, together with a series of clinical and pathological variables,as Predictor of pathological response,lymph node metastasis as well as disease-free(DFS) and overall survival(OS) in LACC patients undergoing neoadjuvant therapy followed by radical surgeryMethods:Between2009-1-2012-12,a total of75patients with stage IB2-IIB Cervical Cancer,who was treated with neoadjuvant therapy followed by radical surgery were investigated.A receiver operating characteristic curve(ROC curve)was used to determine the best NLR/PLR cut-off value in predicting response to neoadjuvant therapy. The relationships between pretreatment variables and response to neoadjuvant therapy were assessed in univariate and multivariate settings.Multipele logistic regression analysis was employed to determine the high-risk factors for LNM.Kaplan-Meier and Cox proportional hazards models were used for survival analysis.Result:The response of neoadjvant therapy was associated with neutrophil-lymphocyte ratio and platelet-lymphocyte ratio (p=0.026and P=0.01,respectively).Multivariate analysis showed that lower NLR and PLR independented predicted well response of neoadjuvant therapy.At a threshold of2.0,the NLR was55.6%sensitive and73.1%specific;at a123.0threshold,the PLR was88.5%sensitive and52.2%specific. In a multivariate analysis,Pre-treatment anemia and grade were independent factors for LNM.By log-rank test,LVSI(p=0.009),LNM(p<0.001),tomor size (P=0.037),NLR(P=0.035),Pre-treatment anemia(p=0.01)and thrombocytosis(P=0.011) were associated with OS in cervical cancer.and progress-free survival was associated with LVSI(p<0.001),LNM(p<0.001),NLR(P=0.029),and thrombocytosis(p=0.009).the variables with P<0.05by the univariate analysis were subjected to a multivariate analysis.On multivariate analysis,only LNM(P=0.017,RR5.375,95%CI1.351-21.379) was independent prognostic variables of overall survival,and LNM (P=0.012, RR4.279,95%CI1.318-23.286),LVSI(P=0.014, RR9.445,95%CI1.563-57.077)were independent prognostic variables of recurrence-free survival. Conclusions:As an easly measured,reproducible,and in expensive marker ofsystemic inflammation,pretreatment NLR and PLR showed a prognostic and independentpredietive value for response to neoadjuvant chemotherapy in locally advanced cervicalcancer. In our preliminary report,preformed on a limited sample,a threshold of2.0forNLR and123.0for PLR seems to be helpful to distinguish between―optimal‖and―non-optimal‖response.pre-tretment anemia and thrombocytosis were independent riskfactors to predict LNM.pre-treatment anema and thrombocytosis seem to be negativeprognostic of long-term outcome.LNM still to be the independent prognostic factors forcervical cancer,and it is recommend that the number of LNM＞3implyed a worseprognosis in cervical cancer.