Neoadjuvant chemotherapy followed by radical surgery versus primary surgery in stage IB2-IIB cervical adenocarcinoma: a retrospective study

This retrospective study was conducted to compare the survival outcomes of patients with cervical adenocarcinoma treated with neoadjuvant chemotherapy followed by radical surgery (NACT + RS) compared to those treated with primary surgery (PS) only. The data of stage IB2-IIB cervical adenocarcinoma patients treated with NACT + RS or PS at our institution were retrieved and assessed. Kaplan-Meier analysis was conducted to compare the survival differences between the investigated treatment groups. Cox proportional hazards model was used to identify potential prognostic factors. A total of 45 patients were eligible for this study, with 20 patients in the NACT + RS group and 25 in the PS group. The 3-year overall survival (OS) of patients from the NACT + RS group was 79.7%, while it was 84.0% for those in the PS group, but the difference was not statistically significant (p = 0.974). In addition, their corresponding 3-year progression free survival (PFS) was also comparable, at 70.0% and 80.0%, respectively (p = 0.716). Of the responders and non-responders to neoadjuvant therapy who underwent NACT + RS, their corresponding 3-year OS was 100.0% versus 53.3% (p = 0.013), and their 3 year PFS was 90.9% versus 44.4% (p = 0.016), respectively. The incidences of lymph node metastasis, parametrial invasion, surgical margin involvement, lymphovascular space invasion and deep stromal invasion were comparable between the two treatment groups. Multivariate analysis showed that lymph node metastasis was an independent prognostic factor for PFS. In conclusion, neoadjuvant chemotherapy followed by radical surgery was not associated with improved survival prognosis or reduced pathological risk factors in patients with stage IB2-IIB cervical adenocarcinoma, but response to neoadjuvant chemotherapy could be a potential indicator of better prognosis.