| Objective:To evaluate the recent efficacy, recurrence and survival rate of neoadjuvant chemotherapy in patients with cervical cancer and metastasis; to analyze the various factors that may affect the curative efficacy.Materials and method:By searching MEDLINE database, PUBMED database, Wanfang Data, China Knowledge Resource Integrated Database with computer and searching books and magazines in the Libraries of Shandong University and the Third People’s Hospital of Jinan with manual retrieval to get information about neoadjuvant chemotherapy in cervical cancer patients. All the literatures in English and Chinese were used in the studies. The collected data were evaluated to discard the articles with low quality data or non-related information with the research. The test group contains the patients were initially treated with neoadjuvant chemotherapy and surgery, while the control group contains the patients were initially treated only with surgery. Total1332patients in eleven clinical trials (five RCT trials and six CCTS trials) were selected for the studies. Except one in CCTS trials grouped patients based on disease stage, age and personal wishes, the other trials did not detailed describe the grouping method. All the trials were not mentioned whether blind study was used. RevMan5.1software was used for meta-analysis of the data. To calculate the RR values, the patients’ clinical curative efficacy, intraoperative and postoperative situation, the side effects of chemotherapy, post operative pathology (lymph node metastasis, parametrial invasion, vascular tumor emboli, vaginal margin invasion and deep stromal invasion of the cervix) and metastasis, recurrence and survival rate in3years and5years as curative effect observation indexes were used. By comparing the RR values in the patients with controls, the factors that may affect the curative effect were evaluated.Results:1. The difference in operation time was statistically significant (Ⅳ,12.53,95%CI,[18.09,6.97], P<0.0001) in the test group comparing with the controls. However, no statistically significant difference was detected in blood loss during operation (Ⅳ,15.88,95%CI,[76.87,45.1], P=0.61) as well as in postoperative urinary retention (RR,0.70,95%CI,[0.21,2.32], P=0.56).2. The pathological changes:The statistically significant difference was detected in the rate of positive surgical margins (RR,0.55,95%CI,[0.37,0.82], P=0.003), lymph node metastasis (RR,0.51,95%CI,[0.38,0.70], P<0.0001), parametrial infiltration (RR,0.51,95%CI,[0.31,0.90], P=0.02) and vascular space invasion (RR,0.41,95%CI,[0.29,0.56], P<0.00001) between the test group and controls.3. Overall survival rate:The difference in3-year survival rate was statistically significant (RR,1.12,95%CI,[0.98,1.28], P=0.01) as well as in the5-year survival rate (RR,1.12,95%CI,[1.04,1.22], P=0.005) between the test group and controls.4. The difference in recurrence rate was statistically significant (RR,0.57,95%CI,[0.34,0.97], P=0.04) between the test group and controls.5. The difference in distant metastasis rate was statistically significant (RR,0.37,95%CI,[0.17,0.82], P=0.01) between the test group and controls.Conclusion:Neoadjuvant chemotherapy and surgery can shorten the operation time, but it cannot reduce the intraoperative blood loss and incidence of postoperative urinary retention. It also can reduce the incidence of pathologic prognostic risk factors, including positive surgical margins, lymph node metastasis, parametrial infiltration and vascular space invasion. It also can reduce the incidence of recurrence rate and distant metastasis rate.Neoadjuvant chemotherapy can also improve3-year and5-year survival rate in the patients. In this study, we cannot determine the effects of age, tumor size, pathological type and differentiation, route of administration and the chemotherapy protocol on the efficacy of neoadjuvant chemotherapy. |
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