| Background: Cervical cancer is the most common malignant tumor of the female reproductive tract,and it is a disease that seriously endangers women’s health.It ranks fourth in terms of morbidity and mortality in the world.Preoperative neoadjuvant chemotherapy is an important part of comprehensive treatment for cervical cancer,but among the results of various randomized controlled trials,preoperative neoadjuvant chemotherapy has a controversial effect on the prognosis of cervical cancer.Objective: In this study,meta-analysis was used to evaluate all the randomized controlled trials about the effect of preoperative neoadjuvant chemotherapy on the prognosis of patients with stage Ⅰ B-Ⅱ B cervical cancer,and to explore whether preoperative neoadjuvant chemotherapy could improve the survival of patients with IB-Ⅱ B cervical cancer and reduce the incidence of pathological risk factors affecting prognosis.Methods: The published randomized controlled trials were searched in the database,including Cochrane Library,CNKI,CBM,Wanfang,VIP,Pub Med,Excerpt Medica Database,Web of Science and so on.The literatures,which compare the therapeutic effects of Neoadjuvant chemotherapy+ Radical hysterectomy(NACT+RH)and Radical hysterectomy alone(RH),were selected.According to the established criteria,the literature was screened and included,and the quality of the literature was evaluated according to the improved Jadad score scale,and the low-quality literature was excluded.The extracted outcome indexes include survival rate,disease-free survival rate and pathological risk factors affecting prognosis,in which survival rate includes 1-year,2-year,3-year and 5-year survival rate,disease-free survival rate includes3-year and 5-year disease-free survival rate.Pathological high-risk and medium-risk factors affecting prognosis include lymph node metastasis rate,para-uterine infiltration rate,vaginal margin positive rate,vascular invasion rate and deep muscle invasion rate.Meta analysis was performed by Revman5.3 software to evaluate whether NACT+RH can improve the survival of patients with IB-stage Ⅱ B cervical cancer and reduce the incidence of pathological risk factors affecting prognosis.Results: A total of 17 items of RCT met the inclusion criteria,including 2013 patients,including 1014 patients in NACT+RH group and 999 patients in RH group.The results showed that: 1.There was no significant difference in survival rate and disease-free survival rate between NACT+RH group and RH group: 1-year survival rate [OR=1.11,95%CI(0.58-2.15,0.75)],2-year survival rate [OR=1.03,95%CI(0.31-3.49,0.96)],3-year survival rate[OR=0.77,95%CI(0.54,0.15)],5-year survival rate [OR=1.23].3-year disease-free survival rate(95%CI),3-year disease-free survival rate(OR=0.95,95%CI),5-year disease-free survival rate(OR=1.30,95%CI),disease-free survival rate(DFS),disease-free survival rate,disease-free survival rate and disease-free survival rate.2.There was no significant difference in the overall survival rate among different tumor stages(Purge 0.52),chemotherapy regimen(Purge 0.05),effective rate of chemotherapy(0.48)and course of chemotherapy(0.33),the difference was not statistically significant.3.NACT+RH can reduce the incidence of postoperative pathological high-risk and medium-risk factors: para-uterine infiltration rate [OR=0.36,95%CI(0.24-0.53),P<0.00001),lymph node positive rate [OR=0.54,95%CI(0.44-0.68),P<0.00001],vaginal margin positive rate [OR=0.37,95%CI(0.22-0.64),P<0.00001)],vascular infiltration rate[OR=0.48].95%CI(0.36-0.63),P < 0.00001)and deep muscle infiltration rate[OR=0.45,95%CI(0.32-0.63),P < 0.00001),the difference was statistically significant.Conclusion: The results of this study showed that for locally advanced cervical cancer(stage IB-IIB),compared with RH,NACT+RH could reduce the incidence of pathological risk factors affecting prognosis,such as para-uterine infiltration rate,lymph node positive rate,vaginal margin positive rate,vascular infiltration rate and deep myometrial invasion,but could not improve the survival rate and disease-free survival rate of patients.The effects of different tumor stages,chemotherapy regimens,effective rates of chemotherapy and course of chemotherapy on the overall survival rate were not statistically significant.Therefore,the clinical choice of NACT as the treatment of locally advanced cervical cancer needs to be cautious,and the possible advantages and disadvantages of the treatment need to be fully explained to the patients and their families before treatment. |
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