[Effects of pre-chemotherapy hemoglobin and platelet levels in patients with stage Ib2-IIb cervical cancer treated with neoadjuvant chemotherapy followed by radical hysterectomy].

Objective: To investigate the role of pre-chemotherapy hemoglobin and platelet levels in the effect of chemotherapy and prognostic outcome in patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ib2-IIb cervical cancer treated with neoadjuvant chemotherapy followed by radical hysterectomy.

Methods: From January 1999 to December 2010, 111 patients with FIGO stage Ib2-IIb who underwent chemosurgical treatment at the department of obstetrics and gynecology in Peking Union Medical College Hospital were reviewed. The median age of patients was 42 years (range: 21 - 68 years). The median level of prechemotherapy hemoglobin and platelet levels was 127 g/L and 266 × 10(9)/L, respectively. Chemotherapy response was evaluated according to the WHO criteria, including complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Patients who achieved CR or PR were defined as responder. Rates of clinical response were compared with the clinical-pathological variables using chi-square test. Multiple logistic regression was carried out to evaluate the relationship among the probability of achieving an optimal clinical response and the variables. The log-rank test was used to compare the homogeneity of progression-free survival and overall survival functions across strata defined by categories of prognostic variables. The Cox proportional hazard model was used to assess the significance of potential prognostic factors for progression-free survival and overall survival.

Results: All patients received one to three cycles of chemotherapy. After the neoadjuvant chemotherapy, 9 patients achieved CR, 77 patients PR, 23 patients SD, 2 patients PD. The overall response rate was 77.5% (86/111). By univariate analysis, the clinical response rate was associated with tumor grade (P = 0.026), deep cervical stromal invasion (P = 0.029) and positive lymph nodes (P = 0.048). By multiple logistic regression, deep cervical stromal invasion (P = 0.015) and positive lymph nodes (P = 0.031) were independent predictors of optimal clinical response. By log-rank test, 5-year overall survival rate and 5-year progression-free survival rate were associated with lymph nodes metastases status and lymphovascular invasion (P = 0.000), but not with hemoglobin and platelet levels (P > 0.05). By Cox regression model, lymph nodes metastases status and lymph-vascular space involvement (P < 0.01) were independently prognostic factors of 5-year overall survival rate and 5-year progression-free survival rate.

Conclusion: Pretreatment hemoglobin and platelet levels were neither predictors of clinical response to chemotherapy nor prognostic factors.