Pathological response on surgical samples is an independent prognostic variable for patients with Stage Ib2–IIb cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy: An Italian multicenter retrospective study (CTF Study) ^☆

^a Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
^b Department of Gynecology and Obstetrics, University of Brescia, Brescia, Italy
^c Unit of Gynecology and Obstetrics, Umberto I Hospital, Venice–Mestre, Italy
^d Department of Surgical Science, University of Turin, Italy
^e Department of Gynecology, Cervical Cancer Center, European Institute of Oncology, Milan, Italy

Open Access

Highlights

•: Neoadjuvant chemotherapy to surgery is an alternative option to chemoradiation for locally advanced cervical cancer.
•: Pathological response rate correlates with survival.

Abstract

Objectives

The purpose of this retrospective multicenter study was to correlate patterns of recurrences and clinical outcome of cervical cancer patients who underwent neoadjuvant chemotherapy [NACT] to surgery.

Methods

This study was conducted on 333 patients with FIGO stage Ib2–IIb cervical cancer who underwent NACT to surgery with pelvic lymphadenectomy. The median follow-up was 66.5 months (range, 8–212 months). Overall optimal response rate was the sum of complete and optimal partial response rates.

Results

An overall optimal response was obtained in 64 patients (19.2%). As for the 220 sub-optimal responders (66.1%), 127 patients had negative nodes and negative parametria and/or surgical margins, 75 patients had positive nodes with positive or negative parametria and/or surgical margins, and 18 patients had positive parametria and/or surgical margins with negative nodes. At the time of the present analysis, 79 (23.7%) of the 333 patients had a recurrence after a median time of 14.9 months (range, 4.5–123 months). Recurrent disease was pelvic in 50 (63.3%), extra-pelvic in 22 (27.9%), and both in 7 (8.8%). On multivariate analysis, pathological response to NACT was an independent prognostic variable for recurrence-free and overall survival. Patients who did not achieve an overall optimal response had a 2.757-fold higher risk of recurrence and a 5.413-fold higher risk of death than those who obtained an overall optimal response.

Conclusions

Results appear to suggest that the chemo-surgical approach is an effective therapeutic option for patients with stage Ib2–IIb cervical cancer and that pathological response to NACT is the strongest prognostic factor for the outcome.