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Efficacy and safety of neoadjuvant chemotherapy followed by radical surgery vs. radical surgery alone in locally advanced cervical cancer: A systematic review and meta‑analysis

  • Authors:
    • Fang Wang
    • Rui Pang
    • Yang Zhang
  • View Affiliations / Copyright

    Affiliations: Department of Gynecology, Xuzhou Medical University Affiliated Hospital of Lianyungan, Lianyungang, Jiangsu 222061, P.R. China
    Copyright: © Wang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 40
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    Published online on: January 26, 2026
       https://doi.org/10.3892/br.2026.2113
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Abstract

Locally advanced cervical cancer (LACC) poses a significant therapeutic challenge, particularly in defining the optimal role of neoadjuvant chemotherapy (NACT) followed by radical surgery (RS) relative to surgery alone. Existing literature offers conflicting evidence on survival benefits, highlighting the need for further clarification. In the present study, the PubMed, EMBASE, Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews databases were systematically searched for studies comparing NACT plus RS vs. RS alone in patients with International Federation of Gynecology and Obstetrics stage IB2‑IIB cervical cancer. Eligible trials reported at least one major outcome [overall survival (OS) or disease‑free survival (DFS)]. Odds ratios (ORs) were calculated using a random‑effects model. Sensitivity analyses, assessment of publication bias and quality evaluations were performed. Seven studies encompassing 2,231 patients were included. The pooled estimate for DFS did not differ significantly between groups (OR, 0.98; 95% CI, 0.62‑1.56; P=0.941), despite some individual studies showing improvements. Subgroup meta‑analysis of OS found a significant advantage favoring NACT plus RS (OR, 0.53; 95% CI, 0.32‑0.87; P=0.012). However, when all OS data were combined, the observed benefit approached but did not achieve statistical significance (OR, 0.74; 95% CI, 0.53‑1.04; P=0.078). Leave‑one‑out sensitivity analyses confirmed the robustness of findings for OS and the consistent null effect for DFS. Publication bias assessments were largely negative, indicating minimal risk of missing or selectively reported studies. The NACT group had lower postoperative complications and radiotherapy needs but higher hematological toxicity and surgical complexity. In conclusion, NACT followed by RS may confer a borderline or subgroup‑specific survival advantage over RS alone for LACC. However, the overall benefit remains inconclusive for DFS. Clinicians should balance potential gains against treatment‑associated risks when considering NACT in routine practice.

View Figures

Figure 1

PRISMA flowchart of study selection.
Flowchart illustrating the systematic search and selection process
for included studies, detailing the number of records identified,
screened, excluded and ultimately analyzed in the
meta-analysis.

Figure 2

Forest plots comparing DFS and OS in
NACT + RS vs. RS alone. Pooled ORs and 95% CIs for DFS are
presented, showing no significant difference between NACT + RS and
RS alone (OR, 0.98; P=0.941). Pooled OS data are presented, with a
significant benefit shown in subgroup analysis (OR, 0.53; P=0.012);
however, when all OS and DFS data were combined, the advantage
approached but did not reach statistical significance (OR, 0.74;
P=0.078). Kim et al (16)
-0, -1~2 and -3 represent the number of metastatic lymph nodes;
this study statistically analyzed OS and DFS after grouping based
on the number of lymph node metastases. Namkoong et al
(14) 1995 a and b represent
squamous cell carcinoma and adenocarcinoma, respectively. DFS,
disease-free survival; OS, overall survival; NACT, neoadjuvant
chemotherapy; RS, radical surgery; OR, odds ratio; CI, confidence
interval.

Figure 3

Leave-one-out sensitivity analysis for
OS and DFS. Leave-one-out sensitivity analysis presented for (A) OS
and (B) DFS in patients treated with NACT followed by RS vs. RS
alone. (A) The exclusion of individual studies yields ORs
consistently <1.0, with statistically significant P-values,
indicating a stable OS benefit for NACT + RS. (B) By contrast,
excluding individual studies does not meaningfully alter the DFS
estimate, with ORs consistently near 1.0 and non-significant
P-values, confirming the robustness of the null effect on DFS. Kim
et al (16) -0, -1~2 and -3
represent the number of metastatic lymph nodes; this study
statistically analyzed OS and DFS after grouping based on the
number of lymph node metastases. Namkoong et al (14) 1995 a and b represent squamous cell
carcinoma and adenocarcinoma, respectively. OS, overall survival;
DFS, disease-free survival; NACT, neoadjuvant chemotherapy; RS,
radical surgery; OR, odds ratio; CI, confidence interval.

Figure 4

Funnel plot for publication bias
assessment. Funnel plot evaluating potential publication bias in
the included studies by plotting the standard error against the log
odds ratio. The relatively symmetrical distribution of data points
suggests minimal risk of bias. Further statistical tests, including
Begg and Mazumdar's rank correlation, and Egger's regression test,
support the absence of small-study effects, confirming that the
overall meta-analysis results are unlikely to be influenced by
publication bias.

Figure 5

Prediction interval analysis of true
effects. Distribution of true effects in the meta-analysis is
presented. The mean effect size is 0.98, with a 95% confidence
interval ranging from 0.62 to 1.56, indicating no significant
overall effect of neoadjuvant chemotherapy followed by RS compared
with RS alone. The prediction interval (0.21 to 4.71) highlights
the potential variability of true effects in different populations,
suggesting that while some subgroups may benefit, others may not.
This emphasizes the heterogeneity in treatment outcomes across
different clinical settings. RS, radical surgery.
View References

1 

Mereu L, Pecorino B, Ferrara M, Tomaselli V, Scibilia G and Scollo P: Neoadjuvant chemotherapy plus radical surgery in locally advanced cervical cancer: Retrospective single-center study. Cancers (Basel). 15(5207)2023.PubMed/NCBI View Article : Google Scholar

2 

de Foucher T, Bendifallah S, Ouldamer L, Bricou A, Lavoue V, Varinot J, Canlorbe G, Carcopino X, Raimond E, Monnier L, et al: Patterns of recurrence and prognosis in locally advanced FIGO stage IB2 to IIB cervical cancer: Retrospective multicentre study from the FRANCOGYN group. Eur J Surg Oncol. 45:659–665. 2019.PubMed/NCBI View Article : Google Scholar

3 

Qiu J, Sun S, Liu Q, Fu J, Huang Y and Hua K: A comparison of concurrent chemoradiotherapy and radical surgery in patients with specific locally advanced cervical cancer (stage IB3, IIA2, IIICr): Trial protocol for a randomized controlled study (C-CRAL trial). J Gynecol Oncol. 34(e64)2023.PubMed/NCBI View Article : Google Scholar

4 

Gadducci A and Cosio S: Neoadjuvant chemotherapy in locally advanced cervical cancer: Review of the literature and perspectives of clinical research. Anticancer Res. 40:4819–4828. 2020.PubMed/NCBI View Article : Google Scholar

5 

Behtash N, Nazari Z, Ayatollahi H, Modarres M, Ghaemmaghami F and Mousavi A: Neoadjuvant chemotherapy and radical surgery compared to radical surgery alone in bulky stage IB-IIA cervical cancer. Eur J Surg Oncol. 32:1226–1230. 2006.PubMed/NCBI View Article : Google Scholar

6 

Chen H, Liang C, Zhang L, Huang S and Wu X: Clinical efficacy of modified preoperative neoadjuvant chemotherapy in the treatment of locally advanced (stage IB2 to IIB) cervical cancer: Randomized study. Gynecol Oncol. 110:308–315. 2008.PubMed/NCBI View Article : Google Scholar

7 

Gong L, Zhang JW, Yin RT, Wang P, Liu H, Zheng Y, Lou JY and Peng ZL: Safety and efficacy of neoadjuvant chemotherapy followed by radical surgery versus radical surgery alone in locally advanced cervical cancer patients. Int J Gynecol Cancer. 26:722–728. 2016.PubMed/NCBI View Article : Google Scholar

8 

Katsumata N, Yoshikawa H, Kobayashi H, Saito T, Kuzuya K, Nakanishi T, Yasugi T, Yaegashi N, Yokota H, Kodama S, et al: Phase III randomised controlled trial of neoadjuvant chemotherapy plus radical surgery vs radical surgery alone for stages IB2, IIA2, and IIB cervical cancer: A Japan clinical oncology group trial (JCOG 0102). Br J Cancer. 108:1957–1963. 2013.PubMed/NCBI View Article : Google Scholar

9 

Zhao H, He Y, Yang SL, Zhao Q and Wu YM: Neoadjuvant chemotherapy with radical surgery vs radical surgery alone for cervical cancer: A systematic review and meta-analysis. Onco Targets Ther. 12:1881–1891. 2019.PubMed/NCBI View Article : Google Scholar

10 

Cibula D, Raspollini MR, Planchamp F, Centeno C, Chargari C, Felix A, Fischerová D, Jahnn-Kuch D, Joly F, Kohler C, et al: ESGO/ESTRO/ESP guidelines for the management of patients with cervical cancer-update 2023. Int J Gynecol Cancer. 33:649–666. 2023.PubMed/NCBI View Article : Google Scholar

11 

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, et al: The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 372(n71)2021.PubMed/NCBI View Article : Google Scholar

12 

Vizza E, Corrado G, Zanagnolo V, Tomaselli T, Cutillo G, Mancini E and Maggioni A: Neoadjuvant chemotherapy followed by robotic radical hysterectomy in locally advanced cervical cancer: A multi-institution study. Gynecol Oncol. 133:180–185. 2014.PubMed/NCBI View Article : Google Scholar

13 

Zhang Y, Huang L, Wang D, Ren P, Hong Q and Kang D: The ROBINS-I and the NOS had similar reliability but differed in applicability: A random sampling observational studies of systematic reviews/meta-analysis. J Evid Based Med. 14:112–122. 2021.PubMed/NCBI View Article : Google Scholar

14 

Namkoong SE, Park JS, Kim JW, Bae SN, Han GT, Lee JM, Jung JK and Kim SJ: Comparative study of the patients with locally advanced stages I and II cervical cancer treated by radical surgery with and without preoperative adjuvant chemotherapy. Gynecol Oncol. 59:136–142. 1995.PubMed/NCBI View Article : Google Scholar

15 

Yang Z, Chen D, Zhang J, Yao D, Gao K, Wang H, Liu C, Yu J and Li L: The efficacy and safety of neoadjuvant chemotherapy in the treatment of locally advanced cervical cancer: A randomized multicenter study. Gynecol Oncol. 141:231–239. 2016.PubMed/NCBI View Article : Google Scholar

16 

Kim HS, Kim JH, Chung HH, Kim HJ, Kim YB, Kim JW, Park NH, Song YS and Kang SB: Significance of numbers of metastatic and removed lymph nodes in FIGO stage IB1 to IIA cervical cancer: Primary surgical treatment versus neoadjuvant chemotherapy before surgery. Gynecol Oncol. 121:551–557. 2011.PubMed/NCBI View Article : Google Scholar

17 

Ronsini C, Solazzo MC, Braca E, Andreoli G, Vastarella MG, Cianci S, Capozzi VA, Torella M, Cobellis L and De Franciscis P: Locally advanced cervical cancer: Neoadjuvant treatment versus standard radio-chemotherapy-an updated meta-analysis. Cancers (Basel). 16(2542)2024.PubMed/NCBI View Article : Google Scholar

18 

Coutinho F, Gokhale M, Doran C, Monberg M, Yamada KS and Chen L: Treatment patterns and outcomes among locally advanced cervical cancer patients receiving concurrent chemoradiotherapy. J Clin Oncol. 41(e17511)2023.

19 

Kenter GG, Greggi S, Vergote I, Katsaros D, Kobierski J, van Doorn H, Landoni F, van der Velden J, Reed N, Coens C, et al: Randomized phase III study comparing neoadjuvant chemotherapy followed by surgery versus chemoradiation in stage IB2-IIB cervical cancer: EORTC-55994. J Clin Oncol. 41:5035–5043. 2023.PubMed/NCBI View Article : Google Scholar

20 

Fu Y, Zhu T and Li H: Effectiveness of cervical cancer therapy using neoadjuvant chemotherapy in combination with radical surgery: A meta-analysis. Transl Cancer Res. 6:228–237. 2017.

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Copy and paste a formatted citation
Spandidos Publications style
Wang F, Pang R and Zhang Y: <p>Efficacy and safety of neoadjuvant chemotherapy followed by radical surgery vs. radical surgery alone in locally advanced cervical cancer: A systematic review and meta‑analysis</p>. Biomed Rep 24: 40, 2026.
APA
Wang, F., Pang, R., & Zhang, Y. (2026). <p>Efficacy and safety of neoadjuvant chemotherapy followed by radical surgery vs. radical surgery alone in locally advanced cervical cancer: A systematic review and meta‑analysis</p>. Biomedical Reports, 24, 40. https://doi.org/10.3892/br.2026.2113
MLA
Wang, F., Pang, R., Zhang, Y."<p>Efficacy and safety of neoadjuvant chemotherapy followed by radical surgery vs. radical surgery alone in locally advanced cervical cancer: A systematic review and meta‑analysis</p>". Biomedical Reports 24.3 (2026): 40.
Chicago
Wang, F., Pang, R., Zhang, Y."<p>Efficacy and safety of neoadjuvant chemotherapy followed by radical surgery vs. radical surgery alone in locally advanced cervical cancer: A systematic review and meta‑analysis</p>". Biomedical Reports 24, no. 3 (2026): 40. https://doi.org/10.3892/br.2026.2113
Copy and paste a formatted citation
x
Spandidos Publications style
Wang F, Pang R and Zhang Y: <p>Efficacy and safety of neoadjuvant chemotherapy followed by radical surgery vs. radical surgery alone in locally advanced cervical cancer: A systematic review and meta‑analysis</p>. Biomed Rep 24: 40, 2026.
APA
Wang, F., Pang, R., & Zhang, Y. (2026). <p>Efficacy and safety of neoadjuvant chemotherapy followed by radical surgery vs. radical surgery alone in locally advanced cervical cancer: A systematic review and meta‑analysis</p>. Biomedical Reports, 24, 40. https://doi.org/10.3892/br.2026.2113
MLA
Wang, F., Pang, R., Zhang, Y."<p>Efficacy and safety of neoadjuvant chemotherapy followed by radical surgery vs. radical surgery alone in locally advanced cervical cancer: A systematic review and meta‑analysis</p>". Biomedical Reports 24.3 (2026): 40.
Chicago
Wang, F., Pang, R., Zhang, Y."<p>Efficacy and safety of neoadjuvant chemotherapy followed by radical surgery vs. radical surgery alone in locally advanced cervical cancer: A systematic review and meta‑analysis</p>". Biomedical Reports 24, no. 3 (2026): 40. https://doi.org/10.3892/br.2026.2113
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