Therapeutic impact of neoadjuvant chemotherapy on lymph node metastasis in locally advanced cervical cancer

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of Obstetrics and Gynaecology Research Pub Date : 2025-07-28 DOI:10.1111/jog.70022

Yuka Mizuta, Koji Yamanoi, Taito Miyamoto, Rin Mizuno, Mana Taki, Ryusuke Murakami, Yuki Himoto, Ken Yamaguchi, Junzo Hamanishi, Masaki Mandai

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引用次数: 0

Abstract

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.

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新辅助化疗对局部晚期宫颈癌淋巴结转移的影响

宫颈癌仍然是一个全球性的健康问题。淋巴结（LN）转移，特别是腹主动脉旁淋巴结（PAN）受累，是一个关键的预后因素。虽然新辅助化疗（NAC）后根治性子宫切除术（RH）用于局部晚期宫颈癌，但其对LN转移的治疗效果尚不确定。方法对110例NAC合并RH患者进行回顾性分析。患者分为9例伴有PAN转移的cIIIC2, 81例非cIIIC2鳞状细胞癌（SCC）和20例非鳞状细胞癌（non-SCC）。非ciiic2 SCC病例根据LN状态进一步分为4个亚组：cN1ypN1 （n = 16）、cN1ypN0 （n = 24）、cN0ypN1 （n = 10）和cN0ypN0 （n = 31）。分析NAC对肿瘤和LN大小的影响及生存结果。结果在cIIIC2病例中，yppan阴性患者的5年无进展生存率（PFS）明显优于yppan阳性患者（100% vs 0%, p < 0.0001）。在非scc病例中，ypN1患者（n = 9）的预后差于ypN0患者（n = 11）（5年PFS: 25% vs. 90%, p = 0.0005）。对于非ciiic2 SCC病例，不同SCC亚组的肿瘤收缩率不同：cN0ypN0（- 58.3%）、cN1ypN0（- 45.5%）、cN1ypN1（- 36.4%）和cN0ypN1（- 29.6%）。cN0ypN1病例也表现出明显的复发模式，66.7%发生远处转移；然而，四个ln相关组的预后没有差异。结论NAC可显著改善部分淋巴结转移已消除的患者的预后，尤其是PAN和非scc盆腔转移患者。然而，这种情况是罕见的，强调需要更好的候选人选择和加强治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Obstetrics and Gynaecology Research 医学-妇产科学

CiteScore

3.10

自引率

0.00%

发文量

376

审稿时长

3-6 weeks

期刊介绍： The Journal of Obstetrics and Gynaecology Research is the official Journal of the Asia and Oceania Federation of Obstetrics and Gynecology and of the Japan Society of Obstetrics and Gynecology, and aims to provide a medium for the publication of articles in the fields of obstetrics and gynecology. The Journal publishes original research articles, case reports, review articles and letters to the editor. The Journal will give publication priority to original research articles over case reports. Accepted papers become the exclusive licence of the Journal. Manuscripts are peer reviewed by at least two referees and/or Associate Editors expert in the field of the submitted paper.