title: Prognostic value of responsiveness of neoadjuvant chemotherapy before surgery for patients with stage IB(2)/IIA(2) cervical cancer.
abstract: OBJECTIVE
  To evaluate the factors that might affect the putative survival benefit from pre-operative neoadjuvant chemotherapy (NAC) in patients with early stage bulky cervical cancer.
  
  
  METHODS
  A retrospective review for 304 patients with stage IB(2)/IIA(2) cervical cancer was performed. Two groups were made according to pre-operative NAC or not: NAC group (n=154) and primary surgery group (PST, n=150). Recurrence risks and survival were analyzed.
  
  
  RESULTS
  The total response rate was 72.1%. For those NAC-responders, NAC decreased the ratio of lymphovascular space invasion (0 vs. 4.7%, p=0.022; 0 vs. 3.3%, p=0.052), deep stromal invasion (19.8% vs. 53.5%, p=0.000; 19.8% vs. 29.3%, p=0.08), lymph node metastasis (8.1% vs. 25.6%, p=0.004; 8.1% vs. 17.3%, p=0.031), and the need of adjuvant radiotherapy (5.5% vs. 30.2%, p=0.000; 5.4% vs. 15.3%, p=0.012), whereas improve 5-year PFS rate (94% vs. 86%, p=0.041; 94% vs. 80%, p=0.089) and 5-year OS rate (96% vs. 86%, p=0.015; 96% vs. 82%, p=0.05), as compared with non-responders and PST. Multivariate analysis suggested that the response to NAC is an independent prognostic factor of PFS (HR 0.221, 95% CI 0.048-1.022, p=0.053) and OS (HR 0.126, 95% CI 0.016-1.000, p=0.05); as compared, stage IIA disease demonstrates negative impact upon PFS (HR 4.778, 95% CI 1.490-15.317, p=0.009) and OS (HR 4.142, 95% CI 1.258-13.639, p=0.019).
  
  
  CONCLUSIONS
  Responsiveness of NAC before surgery might be an independent prognostic factor for the patients with early stage bulky cervical cancer.
authors.affiliation: Department of Obstetrics and Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing,400016, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Li
authors.forename: Shen-tao
authors.initials: ST
authors.lastname: Lu
authors.forename: Jing-ge
authors.initials: JG
authors.lastname: Si
authors.forename: Bin
authors.initials: B
authors.lastname: Liu
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.forename: Yao-yu
authors.initials: YY
authors.lastname: Mei
authors.forename: Hua
authors.initials: H
authors.lastname: Linghu
mesh_terms: D000328:Adult; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*