A Meta-analysis Of The The Comparison Of The Efficacy Of Preoperative Neoadjuvant Chemotherapy And Surgery Alone In The Treatment Of StageⅠB-cervical CancerⅡ

In developing countries,cervical cancer(CC)ranks second in female malignancy.At the same time as one of the three most common malignancies of the female reproductive tract,cervical cancer is the only cancer with a clear cause that can be prevented.Despite the continuous enrichment of screening methods,the continuous improvement of screening technology,the widespread use of screening programs,and the advent of human papillomavirus vaccine,the incidence of cervical cancer in foreign countries is declining year by year,but a large proportion of patients are after the diagnosis,the disease has become locally advanced.For this group of people,the current treatment results present a frustrating survival rate.According to statistical data in the past 20 years,it has been found that the incidence of early cervical cancer patients in our country increased significantly,andthe age of onset was very young.Therefore,improving the patient’s quality of life,improving the prognosis of the disease and improving the survival rate have become the main goals and hotspots for the treatment of cervical cancer.Neoadjuvant chemotherapy(NACT)can inhibit the proliferation of cancer cells,reduce tumor volume,improve the hypoxic environment of cells and reduce the number of non-chemically-sensitive quiescent cells,avoid the possibility of drug-resistant clones,and preserve pelvic organ function,thereby reducing the incidence of postoperative pathological risk factors,improve the surgical resection rate,improve the prognosis and improve the quality of life.Due to the younger age of cervical cancer,early cervical cancer is more common,and the treatment is mainly based on surgery.Therefore,this study analyzed the clinical and pathological effects of preoperative neoadjuvant chemotherapy(NACT+RH)and radical hysterectomy(RH)on stage IBII cervical cancer patients.Objective:The purpose of this study was to compare the clinical and pathological effects of NACT+RH and RH in patients with stage IB–II cervical cancer.To further clarify the significance of NACT+RH to improve the prognosis of cervical cancer patients and the high risk pathological factors after operation,and provide a theoretical basis for its clinical application.Methods:The published randomized reference literature was searched through databases such as PubMed,EMbase,Cochrane Library,Web of Science,CNKI,CBM,and Wanfang.To compare the clinical and pathological efficacy of NACT+RH and RH in cervical cancer patients.Based on the defined inclusion and exclusion criteria,the final inclusion of the literature was determined and the quality assessment was performed according to the Cochrane Quality Assessment Form.The indicators included: 5 year survival rate(5-OS),5 year disease free survival rate(5-DFS),lymph node metastasis rate,parametrial infiltration rate,vascular invasion rate,positive surgical margin rate,postoperative recurrence rate and postoperative radiotherapy rate.The meta-analysis was performed by Revman 5.3 software to evaluate the clinical and pathological effects of NACT+RH on cervical cancer patients.Results:A total of 14 studies met the inclusion criteria and were all randomized controlled trials(RCT),comprising 1694 patients,862 in NACT+RH group and 832 in RH group.NACT+RH group compared with RH group,can improve the 5-OS [OR=1.44,95%CI(1.10-1.88),P=0.008] and reduce lymph node metastasis rate [OR=0.48,95%CI(0.38-0.61),P < 0.00001],parametrial infiltration rate [OR=0.38,95%CI(0.25-0.57),P < 0.00001] and vascular invasion rate [OR=0.39,95%CI(0.20-0.78),P=0.007].But to improve the 5-DFS [OR=1.20,95%CI(0.87-1.66),P=0.27],reduce the positive surgical margin rate [OR=0.48,95%CI(0.10-2.30),P=0.36],the postoperative recurrence rate [OR=0.74,95%CI(0.51-1.06),P=0.10] and postoperative radiotherapy rate [OR=0.56,95%CI(0.28-1.13),P=0.11],had no obvious significance.Conclusion:1.NACT+RH can reduce the rate of lymph nodemetastasis,the parametrial infiltration rate and the parametrial infiltration rate in patients with stage IB-II cervical cancer.It is indicated that NACT+RH can improve the prognosis of pathology.3.NACT+RH can improve the 5-OS of patients with stage IB-II cervical cancer.It is indicated that NACT+RH therapy can prolong the patient’s survival time and improve the clinical prognosis.