# Evaluation of neoadjuvant chemotherapy followed by radical hysterectomy in cervical cancer: a single-center study

## TL;DR

This study examines the effectiveness of neoadjuvant chemotherapy followed by surgery for cervical cancer, finding promising long-term outcomes for early-stage cases but uncertain results for more advanced stages.

## Contribution

The study provides stage-specific insights into the outcomes of neoadjuvant chemotherapy followed by radical hysterectomy for cervical cancer.

## Key findings

- For cT1b3 patients, NACT-RH showed encouraging long-term survival rates.
- In cT2 cases, NACT-RH outcomes were uncertain and varied based on chemotherapy response.
- Non-responders to NACT had worse outcomes compared to responders in cT2b cases.

## Abstract

The efficacy of neoadjuvant chemotherapy (NACT) before radical hysterectomy (RH) in cervical cancer remains unclear. We evaluated stage-specific outcomes of NACT-RH at a high-volume center.

This retrospective cohort study included patients with non-metastatic cT1b1–2b cervical cancer who underwent RH between 2013 and 2022. For cT1b cases, prognostic outcomes were compared between patients with cT1b3 (any N) who underwent NACT-RH (High-risk, NACT(+)) and those with cT1b1–1b2 N0 who underwent primary RH (Low-risk, NACT(−)), using propensity score matching. For cT2 cases, NACT-RH versus primary RH was compared using inverse probability weighting to adjust for baseline differences.

Among 191 patients who underwent RH (cT1: n = 99; cT2: n = 92), the matched cT1 cohort comprised 15 High-risk, NACT(+) and 30 Low-risk, NACT(−) patients. Five-year progression-free survival (PFS) was 75.0% (95% confidence interval [CI], 53.4–100.0%) versus 89.9% (95% CI, 79.6–100.0%) (p = 0.427). Overall survival (OS) was 100% in both groups with a median follow-up of > 70 months. In cT2, NACT-RH (n = 73) versus primary RH (n = 19) showed hazard ratios of 2.88 for PFS (95% CI, 0.69–11.97) and 5.64 for OS (95% CI, 0.70–45.35) after baseline adjustment. Among cT2 patients who underwent NACT-RH, PFS and OS were worse in those without an objective response to NACT (n = 18, all cT2b) than in responders.

NACT-RH was associated with encouraging long-term outcomes in cT1b3, whereas outcomes in cT2 cases remain uncertain, supporting careful selection and response-adapted strategies.

The online version contains supplementary material available at 10.1007/s10147-026-02998-0.