Early response to neoadjuvant chemotherapy can help predict long-term survival in patients with cervical cancer

// Xiong Li 1,2,* , Kecheng Huang 1,* , Qinghua Zhang 1,2,* , Jian Shen 2 , Hang Zhou 3 , Runfeng Yang 4 , Lin Wang 1 , Jiong Liu 5 , Jincheng Zhang 6 , Haiying Sun 1 , Yao Jia 1 , Xiaofang Du 1,2 , Haoran Wang 7 , Song Deng 8 , Ting Ding 1 , Jingjing Jiang 1 , Yunping Lu 1 , Shuang Li 1 , Shixuan Wang 1 and Ding Ma 1 1 Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China 2 Department of Obstetrics and Gynecology, Wuhan Central Hospital, Wuhan, Hubei, China 3 Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China 4 Hubei Tumor Hospital, Wuhan, Hubei, China 5 Shanghai Jiao Tong University School of Medicine, Shanghai, China 6 Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China 7 Department of Internal Medicine, Luohe Renmin Hospital, The First Affiliated Hospital of Luohe Medical College, Luohe, Henan, China 8 Department of Obstetrics and Gynecology, University Hospital of Hubei University for Nationalities, Enshi, Hubei, China * These authors have contributed equally to this work Correspondence to: Shuang Li, email: // Shixuan Wang, email: // Ding Ma, email: // Keywords : cervical cancer, clinical response, neoadjuvant chemotherapy (NACT), predictor, disease-free survival (DFS) Received : April 11, 2016 Accepted : August 13, 2016 Published : August 20, 2016 Abstract It is still controversial whether cervical cancer patients with clinical responses after neoadjuvant chemotherapy (NACT) have a better long-term survival or not. This study was designed to investigate the effect of the clinical response on the disease-free survival (DFS) of cervical cancer patients undergoing NACT. A total of 853 patients from a retrospective study were used to evaluate whether the clinical response was an indicator for the long-term response, and 493 patients from a prospective cohort study were used for further evaluation. The survival difference was detected by log-rank test, univariate and multivariate Cox regression and a pooled analysis. The log-rank test revealed that compared with non-responders, the DFS of responders was significantly higher in the retrospective data ( P = 0.007). Univariate Cox regression showed that the clinical response was an indicator of long-term survival in the retrospective study (HR 1.83, 95% CI 1.18-2.85 , P = 0.007). In a multivariate Cox model, the clinical response was still retained as an independent significant prognostic factor in the retrospective study (HR 1.59, 95% CI 1.01-2.50 , P = 0.046). The result was also validated in the prospective data with similar results. These findings implied that the clinical response can be regarded as an independent predictor of DFS.