Abstract
BACKGROUND: The management of stage IB-IIB cervical cancer (CC) remains a matter of debate. Neoadjuvant therapy (NAT) followed by surgery has emerged as a potential alternative to upfront radical surgery. This study aimed to investigate the survival outcomes of NAT followed by surgery in patients with stage IB-IIB CC, using upfront surgery alone as the comparator. METHODS: CC patients who received NAT in Fujian Cancer Hospital between October 2009 and April 2013 were retrospectively enrolled. A 1:1 propensity score matching (PSM) was conducted to select a comparison cohort of surgeries without NAT from the Surveillance, Epidemiology, and End Results Program (SEER) database. Kaplan-Meier and Cox models were used to assess overall survival (OS) between the NAT and non-NAT cohorts, while recurrence-free survival (RFS) was evaluated only in the NAT cohort, as recurrence data were not available in the SEER database. RESULTS: Following PSM, 532 matched patients per cohort (China NAT and SEER non-NAT) were analyzed with comparable baseline characteristics. The 3-year OS (90.1% vs. 81.9%) and 5-year OS (84.6% vs. 76.7%) were significantly higher in the NAT cohort than in the non-NAT cohort (P<0.001). Subgroup analysis of CC patients with stage IB2 and IIB showed that NAT significantly improved OS (P<0.001). The 1-, 3- and 5-year RFS of the NAT cohort were 89.9% [95% confidence interval (CI): 87.4-92.5%], 81.1% (95% CI: 77.8-84.5%), and 76.1% (95% CI: 72.5-79.9%), respectively. Furthermore, significant differences in RFS (P=0.04) among CC patients with stage IB1-2, IIA, and IIB in the NAT cohort were observed, while OS was similar (P=0.08). Patients were categorized by NAT type into neoadjuvant chemoradiotherapy (n=393), radiotherapy (n=89), and chemotherapy (n=50). No significant differences in OS (P=0.96) or RFS (P=0.64) were observed among the subgroups. CONCLUSIONS: The results indicate that NAT offers a better option in the treatment of CC patients with stage IB-IIB.