Background. This study was to compare the efficacy and safety between neoadjuvant chemotherapy followed by radical surgery (NACT+RS) and radiotherapy only (RT) or concurrent chemoradiotherapy (CCRT) for treatment of patients with stage IB2, IIA, or IIB cervical cancer. Method. The electronic databases of PubMed, Embase, and the Cochrane Library were searched to screen relevant studies from their inception to October 2018. Clinical data including overall survival (OS), disease-free survival (DFS), and adverse events were extracted. Egger’s test was used to evaluate the publication bias, and sensitivity analysis was conducted to estimate the robustness of results. Results. Finally, three randomized controlled trials (RCTs) and two case-control studies consisting of 1,275 patients with stage IB2, IIA, or IIB cervical cancer were included in the current study. Overall, pooled results showed no significant differences in OS ((, ) and DFS (, ) for patients treated with NACT+RS compared with RT only or CCRT, but the subgroup analysis showed that the OS and DFS were significantly longer in the NACT+RS groups than the RT or CCRT group (OS: , , ; DFS: , , ) for the population with median follow-up time of more than 60 months. For adverse events, the incidence of thrombocytopenia in the NACT+RS group was significantly higher than that in the RT only or CCRT group (, 95% CI 1.575-6.662), while the incidence of diarrhea was significantly lower than that in the RT only or CCRT group (, 95% CI =0.230-0.890). Conclusion. These findings suggest that the short-term therapeutic effects of the two treatments may be possibly equal for patients with stage IB2-IIB cervical cancer, but the long-term effects for improving OS and DFS may be better using NACT+RS compared with the RT only or CCRT.

中文翻译：

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IB2、IIA 或 IIB 期宫颈癌患者的新辅助化疗后根治性手术与放疗（联合或不联合化疗）：系统评价和荟萃分析。

背景。本研究旨在比较新辅助化疗后根治性手术 (NACT+RS) 与单纯放疗 (RT) 或同步放化疗 (CCRT) 治疗 IB2、IIA 或 IIB 期宫颈癌患者的疗效和安全性。方法。检索 PubMed、Embase 和 Cochrane Library 的电子数据库，筛选从成立到 2018 年 10 月的相关研究。提取包括总生存期 (OS)、无病生存期 (DFS) 和不良事件在内的临床数据。Egger 检验用于评估发表偏倚，并进行敏感性分析以估计结果的稳健性。结果. 最后，三项随机对照试验 (RCT) 和两项病例对照研究由 1,275 名 IB2、IIA 或 IIB 期宫颈癌患者组成。总体而言，汇总结果显示 OS 没有显着差异（（, )和 DFS (, )对于接受 NACT+RS 治疗的患者与仅 RT 或 CCRT 相比，但亚组分析显示，NACT+RS 组的 OS 和 DFS 显着长于 RT 或 CCRT 组（OS：, , ; 文件系统：, , )中位随访时间超过 60 个月的人群。对于不良事件，NACT+RS 组的血小板减少症发生率显着高于单纯放疗或 CCRT 组（, 95% CI 1.575-6.662），而腹泻的发生率明显低于单纯放疗组或CCRT组（, 95% CI =0.230-0.890)。结论。这些发现表明，对于 IB2-IIB 期宫颈癌患者，两种治疗的短期治疗效果可能相同，但与 RT 相比，使用 NACT+RS 改善 OS 和 DFS 的长期效果可能更好仅或 CCRT。