Background: The treatment of choice for patients with locally advanced cervical cancer (LACC) is definitive concurrent radio chemotherapy which consists of external beam radiotherapy (EBRT) and concurrent platinum-based chemotherapy (CCRT), with the possible addition of brachytherapy (BT). However, the benefits of adjuvant surgery after neoadjuvant treatments remain a debated issue and a still open question in the literature. This meta-analysis aims to provide an updated view on the controversial topic, focusing on comparing surgery after any adjuvant treatment and standard treatment. Methods: Following the recommendations in the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, the PubMed and Embase databases were systematically searched in April 2023 for early publications. No limitations on the country were applied. Only English articles were considered. The comparative studies containing data about disease-free survival (DFS) and/or overall survival (OS) were included in the meta-analysis. Results: The CCRT + surgery group showed a significantly better DFS than CCRT (RR 0.69 [95% CI 0.58–0.81]p< 0.01) and a better OS (RR 0.70 [95% CI 0.55–0.89]p< 0.01). Nine studies comparing neoadjuvant chemotherapy (NACT) plus surgery and CCRT were also enrolled. The NACT + surgery group showed a significantly better DFS than CCRT (RR 0.66 [95% CI 0.45–0.97]p< 0.01) and a better OS (RR 0.56 [95% CI 0.38–0.83]p< 0.01). In the sub-analysis of three randomized control trials, the surgery group documented a non-significantly better DFS and OS than CCRT (OR 1.10 [95% CI 0.67–1.80]p= 0.72; I2= 69%p= 0.72; OR 1.09 [95% CI 0.63–1.91]p= 0.75; I2= 13%p= 0.32). Conclusion: The results provide updated findings about the efficacy of neoadjuvant treatments, indicating significantly improved DFS and OS in patients undergoing hysterectomy after CCRT or NACT compared with patients undergoing standard treatments.
背景：局部晚期宫颈癌（LACC）的标准治疗方案为根治性同步放化疗，包括外照射放疗（EBRT）联合以铂类为基础的同步化疗（CCRT），并可酌情联合近距离放疗（BT）。然而，新辅助治疗后辅助手术的获益在文献中仍存在争议且尚无定论。本荟萃分析旨在就该争议性话题提供最新观点，重点比较任何辅助治疗后手术与标准治疗的疗效差异。方法：遵循系统综述与荟萃分析优先报告条目（PRISMA）声明建议，于2023年4月系统检索PubMed和Embase数据库早期文献，无地域限制，仅纳入英文文献。荟萃分析纳入包含无病生存期（DFS）和/或总生存期（OS）数据的对比研究。结果：CCRT联合手术组较单纯CCRT组显示出显著更优的DFS（RR 0.69 [95% CI 0.58–0.81]p<0.01）和OS（RR 0.70 [95% CI 0.55–0.89]p<0.01）。同时纳入9项比较新辅助化疗（NACT）联合手术与CCRT的研究，NACT联合手术组较CCRT组具有显著更优的DFS（RR 0.66 [95% CI 0.45–0.97]p<0.01）和OS（RR 0.56 [95% CI 0.38–0.83]p<0.01）。在三项随机对照试验的亚组分析中，手术组较CCRT组在DFS和OS方面虽未达统计学显著性差异（OR 1.10 [95% CI 0.67–1.80]p=0.72；I²=69%p=0.72；OR 1.09 [95% CI 0.63–1.91]p=0.75；I²=13%p=0.32），但呈现更优趋势。结论：本研究为新辅助治疗疗效提供了最新证据，表明与接受标准治疗的患者相比，CCRT或NACT后接受子宫切除术的患者在DFS和OS方面均有显著改善。
肿瘤(癌症)患者之家