The journal of obstetrics and gynaecology research · 2025
Therapeutic impact of neoadjuvant chemotherapy on lymph node metastasis in locally advanced cervical cancer.
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Mizuta Yuka, Yamanoi Koji, Miyamoto Taito, Mizuno Rin, Taki Mana, Murakami Ryusuke, Himoto Yuki, Yamaguchi Ken, Hamanishi Junzo, Mandai Masaki
Аннотация
BACKGROUND: Cervical cancer remains a global health concern. Lymph node (LN) metastasis, especially para-aortic LN (PAN) involvement, is a critical prognostic factor. While neoadjuvant chemotherapy (NAC) followed by radical hysterectomy (RH) is used for locally advanced cervical cancer, its therapeutic effect on LN metastases remains uncertain.
METHOD: This retrospective study analyzed 110 patients treated with NAC followed by RH. Patients were grouped into nine cIIIC2 cases with PAN metastasis, 81 non-cIIIC2 squamous cell carcinoma (SCC) cases, and 20 non-squamous cell carcinoma (non-SCC) cases. Non-cIIIC2 SCC cases were further divided into four subgroups by LN status: cN1ypN1 (n = 16), cN1ypN0 (n = 24), cN0ypN1 (n = 10), and cN0ypN0 (n = 31). Tumor and LN size changes by NAC and survival outcomes were analyzed.
RESULTS: In cIIIC2 cases, ypPAN-negative patients showed significantly better 5-year progression-free survival (PFS) compared to ypPAN-positive cases (100% vs. 0%, p < 0.0001). Among non-SCC cases, ypN1 patients (n = 9) had poorer outcomes than ypN0 cases (n = 11) (5-year PFS: 25% vs. 90%, p = 0.0005). As for non-cIIIC2 SCC cases, tumor shrinkage rates varied among SCC subgroups: cN0ypN0 (-58.3%), cN1ypN0 (-45.5%), cN1ypN1 (-36.4%), and cN0ypN1 (-29.6%). cN0ypN1 cases also showed distinct recurrence patterns, with 66.7% experiencing distant metastases; however, prognosis did not differ among four LN-related groups.
CONCLUSION: NAC can significantly improve prognosis in selected cases where LN metastases are eliminated, particularly in PAN and non-SCC pelvic region metastasis cases. However, such cases are rare, emphasizing the need for better candidate selection and enhanced treatment strategies.
METHOD: This retrospective study analyzed 110 patients treated with NAC followed by RH. Patients were grouped into nine cIIIC2 cases with PAN metastasis, 81 non-cIIIC2 squamous cell carcinoma (SCC) cases, and 20 non-squamous cell carcinoma (non-SCC) cases. Non-cIIIC2 SCC cases were further divided into four subgroups by LN status: cN1ypN1 (n = 16), cN1ypN0 (n = 24), cN0ypN1 (n = 10), and cN0ypN0 (n = 31). Tumor and LN size changes by NAC and survival outcomes were analyzed.
RESULTS: In cIIIC2 cases, ypPAN-negative patients showed significantly better 5-year progression-free survival (PFS) compared to ypPAN-positive cases (100% vs. 0%, p < 0.0001). Among non-SCC cases, ypN1 patients (n = 9) had poorer outcomes than ypN0 cases (n = 11) (5-year PFS: 25% vs. 90%, p = 0.0005). As for non-cIIIC2 SCC cases, tumor shrinkage rates varied among SCC subgroups: cN0ypN0 (-58.3%), cN1ypN0 (-45.5%), cN1ypN1 (-36.4%), and cN0ypN1 (-29.6%). cN0ypN1 cases also showed distinct recurrence patterns, with 66.7% experiencing distant metastases; however, prognosis did not differ among four LN-related groups.
CONCLUSION: NAC can significantly improve prognosis in selected cases where LN metastases are eliminated, particularly in PAN and non-SCC pelvic region metastasis cases. However, such cases are rare, emphasizing the need for better candidate selection and enhanced treatment strategies.