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Patterns of First Recurrence and Oncological Outcomes in Locally Advanced Cervical Cancer Patients: Does Surgical Staging Play a Role?

  • 0Gynecologic Oncology Division, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain.
Cancers +

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April 13, 2024

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April 13, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Surgically staging locally advanced cervical cancer (LACC) with paraaortic lymphadenectomy (PALND) led to more frequent recurrences and worse survival rates compared to imaging-based staging (noPALND). This highlights potential risks associated with invasive staging in LACC patients.

Area Of Science

  • Gynecologic Oncology
  • Surgical Oncology
  • Clinical Research

Background

  • Locally advanced cervical cancer (LACC) treatment often involves chemoradiotherapy.
  • Accurate staging is crucial for treatment planning and prognosis assessment.
  • Minimally invasive paraaortic lymphadenectomy (PALND) is a surgical staging method for LACC.

Purpose Of The Study

  • To compare the recurrence patterns and survival outcomes of LACC patients treated with PALND versus those staged by imaging (noPALND).
  • To evaluate the impact of surgical aortic staging on the first site of recurrence and overall survival in LACC.

Main Methods

  • A multicenter, observational, retrospective cohort study involving LACC patients treated between 2000 and 2016.
  • Inclusion criteria: squamous cell carcinoma, adenosquamous carcinoma, or adenocarcinoma; FIGO stages IB2, IIA2-IVA; and primary chemoradiotherapy.
  • Propensity score matching (PSM) was used to minimize bias between the PALND and noPALND groups.

Main Results

  • After PSM, 1092 patients (546 PALND, 546 noPALND) were analyzed. The PALND group showed significantly higher recurrence rates (28.0% vs. 15.0%, p < 0.001).
  • Patients undergoing PALND experienced more frequent regional recurrences (11.2% vs. 2.4%, p < 0.001), particularly at aortic nodes, and distant recurrences (15.6% vs. 7.0%, p < 0.001).
  • The PALND group exhibited poorer overall survival, cancer-specific survival, and disease-free survival compared to the noPALND group.

Conclusions

  • Surgical staging with PALND in LACC patients is associated with increased recurrence rates.
  • Patients undergoing PALND demonstrate inferior survival outcomes compared to those staged non-surgically.
  • The findings suggest that PALND may not improve, and could potentially worsen, outcomes for LACC patients.

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