To explore the efficacy of neoadjuvant chemotherapy (NACT) combined with surgery and concurrent radiochemotherapy in the treatment of cervical cancer patients with International Federation of Gynecology (FIGO) clinical stage Ⅱ_B and its influencing factors.

From January 2010 to December 2018, a total of 196 cervical cancer patients with stage Ⅱ_B who were treated in the Second Affiliated Hospital of Dalian Medical University were selected as research subjects. According to different treatment protocols, they were divided into combined with surgical treatment group (n=95, received NACT combined with surgical treatment) and concurrent radiochemotherapy group (n=101, received concurrent radiochemotherapy only). Retrospective analysis was used to collect overall survival (OS) time, progression-free survival (PFS) time and treatment-related adverse reactions of patients in two groups. The 5-year OS rate and PFS rate of patients in two groups were calculated by Kaplan-Meier method, and was compared by log-rank test. Multivariate Cox proportional hazards regression analysis was performed on analyzing influencing factors of OS time and PFS time of all patients. The incidence of treatment-related adverse reactions between two groups was compared by chi-square test. The procedure followed in this study complied with World Medical Association Declaration of Helsinki revised in 2013.

①The 5-year OS rate and PFS rate of combined surgical treatment group were 91.9% and 84.0%, respectively, which were significantly higher than 64.2% and 64.8% of concurrent radiochemotherapy group, the differences were statistically significant between two groups (χ²=5.920, P=0.015; χ²=4.560, P=0.033). ②The results of multivariate Cox proportional hazard regression analysis of OS and PFS time of all patients in this study showed that treatment method is an independent influencing factor for OS time of these patients (HR=0.267, 95%CI: 0.094-0.758, P=0.013); while treatment methods, pathological types, tumor differentiation, tumor diameter, and age were not independent influencing factors of PFS time of these patients (P>0.05). ③The multivariate Cox proportional hazard regression analysis of OS and PFS time of patients in combined surgical treatment group showed that surgical margin status was an independent influencing factor for OS and PFS time of these patients (HR=0.027, 95%CI: 0.003-0.281, P=0.003; HR=0.004, 95%CI: 0.000-0.197, P=0.006). ④The incidence of radiation cystitis of combined surgical treatment group was 4.2% (4/95), which was significantly lower than 13.9% (14/101) of concurrent radiochemotherapy group, and the difference was statistically significant (χ²=5.467, P=0.019).

For cervical cancer patients with stage Ⅱ_B, preoperative NACT combined with surgical treatment can get better therapeutic effect than those of concurrent radiochemotherapy. For patients undergoing NACT combined with surgery, the status of surgical margin is an independent influencing factor for OS Time and PFS time of these patients. As this study is just a retrospectively study, multi-center, large-sample, and randomized controlled trials are still needed to further confirmed the efficacies of NACT combined with surgery and its influencing factors.