The Influence Of Different Treatment Modes On The Survival Outcome Of Stage ⅡB2～ⅢB Cervical Adenocarcinoma

Objective:To compare the survival outcome of neoadjuvant chemotherapy(NACT)followed by radical surgery plus adjuvant chemoradiotherapy with that of NACT+concomitant chemotherapy and radiotherapy(CCRT)+adjuvant chemotherapy(AC)or CCRT in patients with ⅠB2～ⅢB stage cervical adenocarcinoma.Methods:We retrospectively reviewed our medical records of cervical adenocarcinoma patients treated with NACT+surgery+ARC、NACT+CCRT+AC or CCRT in our institution from January 2013 to December 2017.The patients were treated with two-dimensional radiotherapy or three-dimensional-conformal or intensity-modulated radiotherapy combined with intracavitary brachytherapy.The regimen of concomitant chemotherapy was weekly cisplatin.The NACT was paclitaxel plus cisplatin.The primary end points were overall survival(OS)and progression-free survival(PFS).Results:We enrolled 115 patients.There were 36(31.3%)patients in the NACT+surgery+ARC group and 14(12.2%)in the CCRT group and 65(56.5%)in the NACT+CCRT+AC group.After univariate multivariate analysis,therapy was an independent predictor of OS(p=0.015)and PFS(p=0.012).We performed statistics on NACT+surgery+ARC group and NACT+CCRT+AC group;NACT+surgery+ARC group and CCRT group;CCRT group and NACT+CCRT+AC group.Before Propensity Score Matching(PSM),the 5-year OS of the NACT+surgery+ARC group and the NACT+CCRT+AC group were 17%and 9%,respectively(p=0.009),and the 5-year PFS were 17%and 5%,respectively(p=0.007),the 5-year OS of the two groups after PSM were 23%and 14%(p=0.027),and the 5-year PFS were 23%and 9%(p=0.025),respectively;before matching,the 5-year OS of the NACT+surgery+ARC group and the CCRT were 17%and 29%(p=0.75),and the 5-year PFS were 17%and 29%(p=0.71),respectively,after matching,the 5-year OS of the two groups was 44%,44%(p=0.96),and 5-year PFS were 44%and 44%(p=1.00),respectively;the 5-year 0S of the CCRT and NACT+CCRT+AC groups before matching were 29%and 9%,respectively(p=0.1),the 5-year PFS was 29%,5%(p=0.03);after matching,the 5-year OS of the two groups were 36%,18%(p=0.85)and 36%,18%(p=0.91).Conclusion:For patients with stage ⅡB-ⅢB cervical adenocarcinoma,the treatment model of NACT+surgery+ARC may be more clinically beneficial.For patients who cannot tolerate surgery or do not choose surgery,concurrent radiotherapy and chemotherapy may be the most reasonable treatment mode.