| Background and ObjectiveCervical cancer is a major global health problem for women.It is the fourth most common cancer in the world and the leading cause of cancer death among women in developing countries.Neoadjuvant chemotherapy has been used in the clinical treatment of cervical cancer for more than 30 years,but the screening of its beneficiaries,the balance of advantages and disadvantages and the evaluation of its efficacy are still the direction of recent research development.In this article,through cervical cancer in China big data platform,multicenter clinical diagnosis and treatment of cervical cancer in China give a summary to the present situation of the application of preoperative neoadjuvant chemotherapy,analysis and comparison of different types of cervical cancer(including histology,FIGO staging,gross type,differentiation degree)and different ways of chemotherapy(including the way of chemotherapy,chemotherapy,chemotherapy regimen)preoperative neoadjuvant chemotherapy in the near future curative effect,provides research basis to cervical cancer diagnosis and treatment and data support.Materials and methods1.Source:It mainly comes from the big data survey project of clinical diagnosis and treatment of cervical cancer in China(project 1538 for short).Currently,31,599 cervical cancer cases from 34 hospitals in China have been included and put into the database,among which 5,535 cases of preoperative neoadjuvant chemotherapy have been included.The use of data has been authorized by the organizer.2.Methods:Preliminary statistics were made on all the data,and then further grouping was conducted to compare the short-term efficacy.The histological types were divided into two groups:squamous cell carcinoma and non-squamous cell carcinoma(adenocarcinoma and adenosquamous cell carcinoma).The general types were divided into two groups:exogenous type and non-exogenous type(endogenic type,ulcerative type and cervical type).The degree of differentiation was divided into three groups:high differentiation,medium differentiation and low differentiation.FIGO was divided into three groups:stage IB2,stage IIA2 and stage IIB.The chemotherapy routes were divided into two groups:intravenous chemotherapy and arterial chemotherapy.The chemotherapy regimens were divided into two groups:paclitaxel+platinum,platinum+non-paclitaxel.The tumor diameter was divided into two groups:<4cm and?4cm.3.Statistical method:SPSS 23.0 was used for data processing.The measurement data were expressed as mean±standard deviation,and the independent sample t test was used for statistical analysis.The enumeration data were expressed by the number and percentage of cases,and the comparison between groups was conducted using the chi-square test or Fisher's exact probability method.1:n propensity score matching(PSM)was used for case matching to eliminate the influence of confounders.P<0.05 was considered statistically significant.Results1.Application trend and distribution of preoperative neoadjuvant chemotherapy for cervical cancer in ChinaFrom 2004 to 2016,the application of neoadjuvant chemotherapy increased from 50 cases(0.9%)in 2004 to 542 cases(9.7%)in 2016.The average application percentage of neoadjuvant chemotherapy in rural patients was as high as 57.1%in each year.2.Application status of preoperative neoadjuvant chemotherapy for cervical cancer in ChinaThe application ages of neoadjuvant chemotherapy for cervical cancer in China are mainly distributed in the 36-59 age group.The application of FIGO staging was chaotic,and phase i-iv was adopted,among which IB2,IIA2 and IIB accounted for 61.3%,which constituted the main part of preoperative neoadjuvant chemotherapy.The statistical results of histological types showed that squamous cell carcinoma constituted the vast majority of preoperative neoadjuvant chemotherapy of cervical cancer in China,accounting for 85.5%.The differentiation degree was mainly medium and low,accounting for 93.7%.There were 3502 cases of the general type,accounting for 63.2%.The largest diameter of newly diagnosed tumors was greater than or equal to 4cm,accounting for 52.4%.The choice of chemotherapy route was mainly intravenous chemotherapy,and the proportion was as high as 76.2%.There are various chemotherapy regimens,mainly platinum-based combination drugs.The chemotherapy course is usually 1-2 courses,accounting for up to 86.9%.3.Short-term efficacy of preoperative neoadjuvant chemotherapy for cervical cancer3.1 efficacy of preoperative neoadjuvant chemotherapy for cervical cancer3.1.1 changes in tumor diameter before and after neoadjuvant chemotherapy for cervical cancerAmong the 3206 patients with definite curative effect,the maximum tumor diameter before neoadjuvant chemotherapy was(4.40±1.41)cm,and the maximum tumor diameter after chemotherapy was(3.13±1.50)cm,and t=34.827,P<0.001,the difference was statistically significant.3.1.2 overall effective rate of preoperative neoadjuvant chemotherapy for cervical cancerAccording to the analysis of the current application status of preoperative neoadjuvant chemotherapy in China,the overall effective rate of chemotherapy is 47.9%,which is lower than that reported in the literature.It is mainly related to the confusion of stages applied,the presence of stages ?-?,the variety of chemotherapy regimentation,the existence of some non-standard chemotherapy regimentation,and the non-standard records of cases leading to the lack of efficacy in many cases.3.2 short-term efficacy of preoperative neoadjuvant chemotherapy for different types of cervical cancer3.2.1 different histological typesThe effective rates were 49.7%and 36.9%,respectively,in the post-match squamous cell carcinoma group(259 cases)and the adenocarcinoma and adenosquamous cell carcinoma groups(260 cases),and the difference was statistically significant(P<0.05).3.2.2 different general typesAfter case matching,the effective rates of chemotherapy in the exogenous type group(692 cases)and the non-exogenous type group(693 cases)were 46.4%and 44.4%respectively,and P=0.575 was compared between the two groups,with no statistically significant difference(P>0.05).3.2.3 different degrees of differentiationCases after the match in three sets of differentiation of high,medium and low differentiation recent curative effect comparison,the comparison and analysis between,well-differentiated group vs.the differentiation,high differentiation group vs.low differentiation,differentiation in group vs.low differentiation group effective chemotherapy followed by 46.9 vs.43.4,44.4 vs.47.9,48.7 vs.49.5,corresponding to the P value is 0.422,0.520,0.648,in turn,there were no statistically significant difference(P>0.05).3.2.4 different FIGO stagesCases after matching ?B2 stage,stage ?A2 and ?B three groups in the near future curative effect comparison,by comparison and analysis between,?B2 period group vs.IIA2 period and ?B2 group vs.stage ?B groups,?A2 group vs.stage ?B groups of effective chemotherapy followed by 58.4 vs.60.2,60.7 vs.54.8,60.3 vs.56.8,corresponding to the P value is 0.652,0.392,0.280,in turn,there were no statistically significant difference(P>0.05).3.3 short-term efficacy of preoperative neoadjuvant chemotherapy for cervical cancer with different chemotherapy methods3.3.1 different chemotherapy approachesThe effective rates of chemotherapy in the intravenous chemotherapy group(409 cases)and the arterial chemotherapy group(446 cases)were 42.0%and 43.7%,respectively.The P value of the two groups was 0.553,and the difference was not statistically significant(P>0.05).3.3.2 different chemotherapy regimensThe effective rates of chemotherapy in paclitaxel+platinum group(703 cases)and platinum+non-paclitaxel group(732 cases)were 51.0%and 43.6%,respectively,P=0.005,and the difference was statistically significant.3.3.3 different chemotherapy coursesAfter case matching,the effective rates of chemotherapy were 45.2%and 48.3%in groups with a course of treatment?2(179 cases)and 2 groups with a course of treatment of>(260 cases),respectively.P=0.555 was compared between the two groups,and the difference was not statistically significant.3.4 the effect of tumor diameter on the short-term efficacy of preoperative neoadjuvant chemotherapy for cervical cancerThe effective rates of chemotherapy were 32.6%and 47.2%in the group with the maximum tumor diameter<4cm(578 cases)and the group with the maximum tumor diameter?4cm(780 cases),and the difference was statistically significant(P<0.001).Conclusions1.From 2004 to 2016,the application of preoperative neoadjuvant chemotherapy for cervical cancer in China was on the rise,and rural patients accounted for the majority.2.Application status of preoperative neoadjuvant chemotherapy for cervical cancer in China:the application age is mainly distributed in 36-59 years old;?B2,?A2 and ?B were the main components of preoperative neoadjuvant chemotherapy.The main pathological types were cervical squamous cell carcinoma,most of which were of medium to low differentiation,and most of which were exogenous.The main chemotherapy route is intravenous chemotherapy,and the treatment course is usually 1-2 courses.Platinum-based combination drugs are mainly used in the selection of chemotherapy regimens.3.Compared with cervical adenocarcinoma and adenosquamous carcinoma,the short-term efficacy of preoperative neoadjuvant chemotherapy for cervical squamous carcinoma was better.4.Compared with platinum+non-paclitaxel chemotherapy regimens,the short-term efficacy of paclitaxel+platinum chemotherapy regimens is relatively better.5.The short-term efficacy of preoperative neoadjuvant chemotherapy for cervical cancer with newly diagnosed tumor diameter greater than or equal to 4 cm is better than that of less than 4 cm.6.The short-term efficacy of neoadjuvant chemotherapy before and after chemotherapy was similar for different general types,differentiation degrees,tumor stages,chemotherapy approaches and chemotherapy courses. |
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