Responsiveness of neoadjuvant chemotherapy before surgery predicts favorable prognosis for cervical cancer patients: a meta-analysis

Neoadjuvant chemotherapy (NAC) before surgery has already shown the therapy effectiveness in patients with cervical cancer. The present meta-analysis was conducted to determine whether the response to NAC predicts for prognosis.

Systematic computerized searches of the PubMed and Web of Knowledge were performed. Prognosis outcomes included progression-free survival (PFS), and overall survival (OS). The pooled odd ratio (OR) was estimated by using fixed-effect model or random-effect model according to heterogeneity between studies.

Eighteen studies with 1,785 patients were included. Cisplatin-based NAC treatments were most commonly used. The clinical response rate ranged from 48.4 to 93.0 %, and the pathological response rate ranged from 27.6 to 30.6 %. The pooled ORs estimating the association of PFS with NAC response were 5.707 (95 % CI 3.564–9.137), 6.798 (95 % CI 4.716–9.799), 6.327 (95 % CI 4.398–9.102), and 5.214 (95 % CI 3.748–7.253) at 1-, 2-, 3-, and 5-year follow-up, respectively, and the pooled ORs estimating the association of OS with NAC response were 6.179 (95 % CI 3.390–11.264), 9.155 (95 % CI 5.759–14.555), 8.431 (95 % CI 5.667–12.543), and 5.785 (95 % CI 4.124–8.115) at 1-, 2-, 3-, and 5-year follow-up, respectively. No obvious statistical heterogeneity was detected. Funnel plots and Egger’s tests did not reveal publication bias. Sensitivity analysis showed the results of meta-analysis were robust.

This meta-analysis confirms that response to NAC is an indicator for PFS and OS, and suggests that patients-achieving response of NAC before surgery predicts favorable prognosis for cervical cancer patients.