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Adjuvant chemotherapy after radiotherapy or concurrent chemoradiotherapy for pelvic lymph node-positive patients with locally advanced cervical cancer: a propensity score matching analysis
  1. Yidi Yuan,
  2. Jing You,
  3. Xiaofan Li and
  4. Weihu Wang
  1. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
  1. Correspondence to Dr Weihu Wang, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China; wangweihu88{at}163.com; Dr Xiaofan Li, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China; lxflp{at}163.com

Abstract

Objective The benefit of adjuvant chemotherapy after definitive chemoradiotherapy in patients with pelvic lymph node-positive cervical cancer has been poorly studied. This study aimed to test the hypothesis that the addition of adjuvant chemotherapy to definitive radiotherapy or concurrent chemoradiotherapy improves survival in patients with pelvic lymph node-positive cervical squamous cell carcinoma.

Methods This retrospective study enrolled patients with stage IB–IVA pelvic lymph node-positive cervical squamous cell carcinoma, without para-aortic lymph node metastases and initially treated with definitive radiotherapy or concurrent chemoradiotherapy between March 2007 and February 2018. Patients were classified into the adjuvant chemotherapy (5-fluorouracil or paclitaxel, plus cisplatin) and no-adjuvant chemotherapy groups. Treatment outcomes were compared between the two groups before and after 1:1 ratio propensity score matching.

Results Medical records of 951 patients were reviewed and 792 patients were excluded. Finally, 159 patients were enrolled for analysis. Of these, 42 patients received a median of two cycles (range, 1–6) of adjuvant chemotherapy and 117 patients under observation after primary treatment. The median follow-up period was 33.8 months (range, 2.9–113.0). Before propensity score matching, no significant difference was observed in survivals between the two groups (P>0.05). After propensity score matching, 37 pairs of patients were selected. The 3-year rates of progression-free survival, overall survival, local control, and distant metastasis-free survival in the adjuvant chemotherapy and no-adjuvant chemotherapy groups were 80.2% and 60.4% (P=0.07), 83.0% and 63.7% (P=0.17), 94.0% and 81.9% (P=0.12), and 85.9% and 60.1% (P=0.04), respectively. The incidences of grade 3–4 acute and late toxicities were comparable between the two groups (P>0.05).

Discussion Adjuvant chemotherapy significantly improved 3-year distant metastasis-free survival in patients with pelvic lymph node-positive cervical squamous cell carcinoma. Further prospective studies are needed to provide supportive evidence for the therapeutic efficacy of adjuvant chemotherapy.

  • cervical cancer
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Footnotes

  • YY and JY are joint first authors.

  • XL and WW contributed equally.

  • Contributors YY performed data collection, statistical analysis, and drafted the manuscript. JY helped perform statistical analysis and performed revision of the manuscript. XL aided with data collection and performed revision of the manuscript. WW designed this study and supervised the project.

  • Funding This work was supported by: (1) Science Foundation of Peking University Cancer Hospital No.17-17; (2) Science Foundation of Peking University Cancer Hospital No.18-03; (3) Beijing Municipal Science & Technology Commission No.Z181100001718192; (4) Beijing Natural Science Foundation No.7182028; and (5) Clinical Technology Innovation Project of Beijing Hospital Authority No.XMLX201842.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was ethically approved by the Ethics Committee of Peking University Cancer Hospital and Institute (Institutional Review Board number: 2019JYZ63).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The data analyzed in this study are available from the corresponding authors with reasonable request.

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