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

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.