Article Text
PDF
Abstract
Introduction/Background To evaluate the overall pathologic response to neoadjuvant chemotherapy (NACT) of patients with locally advanced cervical cancer (LACC) describing the critical impact of clinical pathological factors and biomarkers (p53, Bcl1 and Bcl2) on chemoresponsivity and to report the prognostic outcome of NACT.
Methodology This is a retrospective study of 88 consecutive patients with LACC who underwent NACT followed by nerve sparing surgery with retroperitoneal lymphadenectomy at National Cancer Institute of Milan, between January 2000 and June 2013. Clinical pathologic data were retrieved from the institutional database. Biomarkers (p53, Bcl1 and Bcl2) were evaluated before and after NACT in the specimen. To investigate their role as predictors of response, we tried several statistical machine learning algorithms.
Results 55.7% of patients had a pathological response to NACT and showed a 5 years survival between 100% (complete response) and 85.7% (partial response). Age, body mass index (BMI) and grade represented the most important predictors of response at random forest analysis. Area under the curve was 0.8676. Tree based boosting analysis confirmed that after adjusting for other prognostic factors, age, grade, BMI and tumor size were independent predictor of response to NACT, while p53 was moderately related to response to NACT. Whereas Bcl1 and Bcl2, were not predictors for response to NACT. The logistic regression reported that age and grade were significant factors unlike p53.
Conclusion Combined model that included clinical pathologic variables plus p53 cannot predict response to NACT. Despite this, NACT treatment remain a safe treatment in chemosensitive patients avoiding collateral sequelae related to chemo-radiotherapy.
A Combined model. Importance of Clinical factors plus biomarkers pre-treatment as predictors to NACT at the tree based boosting analysis. Area under the curve (crude estimate): 0.8676
Disclosures The Authors declare no conflicts of interest.