Background: Several pretreatment variables have been found to correlate with the clinical outcome of patients treated with NACT plus radical hysterectomy, such as FIGO stage, tumor size, and lymph node status. Methods: A single-center retrospective observational study to evaluate the use of NACT in LACC, particularly in the lymph-node-positive subpopulation. The study, conducted at the Maternal and Child Department of “Cannizzaro Hospital” in Catania, included patients treated between 2009 and 2019. Multivariate analysis was performed to analyze responses to NACT according to clinicopathologic parameters. Kaplan–Meyer disease-free survival (DFS) and overall survival (OS) curves were generated according to different lymph node status subgroups. Results: A total of 151 consecutive patients were enrolled in the study. Significant independent risk factors for response to NACT were preoperative tumor diameter, parametrium involvement, and lymphoma vascular space invasion (LVSI). T initial diameter at NMR was found to be the independent prognostic predictor for general (p= 0.024) and lymph node (LND) response (p= 0.028). Tumors between 2 and 6 cm have a better response to NACT than tumors > 6 cm, and LVSI absence was an independent prognostic factor for LND response to NACT. Survival DFS and OS curves were significant for positive vs. negative pathologic LND. Conclusions: Neoadjuvant chemotherapy followed by surgery cannot be considered a standard of care in patients with locally advanced cervical cancer, particularly in the subgroup with pre-NACT imaging suspected for LND metastases.
背景：多项研究已发现，新辅助化疗联合根治性子宫切除术治疗患者的临床结局与若干治疗前变量相关，如国际妇产科联盟分期、肿瘤大小及淋巴结状态。方法：本研究为单中心回顾性观察性研究，旨在评估新辅助化疗在局部晚期宫颈癌中的应用，特别是在淋巴结阳性亚群中的效果。研究在卡塔尼亚“坎尼扎罗医院”妇产科进行，纳入了2009年至2019年间接受治疗的患者。通过多变量分析，根据临床病理参数评估患者对新辅助化疗的反应。根据不同淋巴结状态亚组，绘制了卡普兰-迈耶无病生存期和总生存期曲线。结果：研究共纳入151例连续患者。对新辅助化疗反应显著的独立危险因素包括术前肿瘤直径、宫旁浸润及淋巴血管间隙侵犯。核磁共振检查显示的初始肿瘤直径被发现是总体反应（p=0.024）和淋巴结反应（p=0.028）的独立预后预测因子。2至6厘米的肿瘤对新辅助化疗的反应优于大于6厘米的肿瘤，且无淋巴血管间隙侵犯是淋巴结对新辅助化疗反应的独立预后因素。在病理淋巴结阳性与阴性患者中，无病生存期和总生存期曲线存在显著差异。结论：新辅助化疗后手术不应被视为局部晚期宫颈癌的标准治疗方案，尤其对于新辅助化疗前影像学检查怀疑淋巴结转移的亚组患者。
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