Neoadjuvant chemotherapy enables fertility preservation without compromising oncologic outcomes in early cervical cancer
A partir d'une revue systématique de la littérature publiée jusqu'en février 2025 (19 études incluant au total 1 453 patients), cette méta-analyse évalue l'effet, sur la fertilité et les résultats oncologiques, d'une chimiothérapie néoadjuvante suivie d'une chirurgie préservant la fertilité chez les patientes atteintes d'un cancer du col de l'utérus de stade précoce (taille supérieure ou égale à 2 cm)
Introduction : Early-stage cervical cancer tumours
≥
2 cm present a dilemma for fertility preservation, as guidelines generally discourage fertility-sparing surgery (FSS) due to oncologic risks. Neoadjuvant chemotherapy (NACT) followed by FSS has emerged as an alternative to downstage tumours. This study evaluated recurrence and pregnancy outcomes of NACT + FSS versus upfront FSS.
Methods : A PROSPERO-registered (CRD42024605906) meta-analysis was conducted using PubMed, EMBASE, and Cochrane (updated Feb 26, 2025). Eligible studies included women with early-stage cervical cancer (FIGO 2018 IB2–IIA1;
≥
2 cm) undergoing upfront FSS or NACT + FSS. Pooled proportions with 95% confidence intervals (CIs) were calculated using a random effects model.
Results : Nineteen observational studies (n = 1453) were analysed. Indirect comparison indicated significantly higher pooled pregnancy rate for NACT + FSS (31%; 95% CI: 23–41%) compared to upfront FSS (8%; CI: 1–43%; p = 0.002). Pooled recurrence rate was statistically similar: 10% (CI: 5–20%) for upfront FSS and 13% (CI: 9–20%) for NACT + FSS (p = 0.415). Studies generally exhibited a moderate-to-high risk of bias.
Conclusion : NACT followed by FSS appears to enhance fertility outcomes without increasing oncologic risk compared to upfront FSS in patients with tumours
≥
2 cm. These findings support the personalized extension of fertility-sparing indications, though prospective validation remains necessary.
European Journal of Surgical Oncology , article en libre accès, 2026