系统评价宫颈癌术前应用新辅助化疗的临床价值

Objective To evaluate clinical value of neoadjuvant chemotherapy(NACT) before surgery for cervical cancer. Methods The author searched the clinical trials on the treatment of cervical cancer comparing NACT followed by surgery versus initial surgery in the main medical data resources(MEDLINE、PUBMED、ELSEVIER ScienceDirect、CNKI、CBMdisc、Cochrane Library and EMBASE)published in English and Chinese literature. We abstracted data about positive pelvic nodes, interstitial infiltration, vascular invasion, positive surgical margin,3-year overall survival (OS),3-year disease-free survival(DFS),5-year OS,5-year DFS from both NACT group and control group, and a meta-analysis was applied. Results The hazard ratio (HR) of positive pelvic nodes on NACT group versus control group was 0.52 (95 % CI 0.42 ～ 0.64, P<0.0001), HR of interstitial infiltration was 0.41 (95 % CI 0.32 ～ 0.55, P<0.0001), HR of vascular invasion was 0.25 (95 % CI 0.16 ～0.38, P<0.0001), and HR of positive surgical margin was 0.44 (95 % CI 0.22 ～ 0.87, P=0.02), all differences were statistically significant. And there were significant difference on the HRs of 3-year DFS, and 5-year DFS, which were 1.45 (95% CI 1.10 ～ 1.91,P=0.008)and 1.33 (95 % CI 1.05 ～ 1.77,P=0.04). And there were no significant difference on HRs of 3-year OS and 5-year OS, which were 1.11 (95 % CI 0.85 ～ 1.46, P =0.46)and 1.11(95%CI 0.87 ～1.40,P= 0.40)respectively. Conclusion For cervical cancer,NACT could reduce pathological risk factors and maybe improve prognosis.

Clinical value of neoadjuvant chemotherapy before surgery for cervical cancer: A Meta-analysis