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An Orthotopic Endometrial Cancer Model with Retroperitoneal Lymphadenopathy Made From In Vivo Propagated and Cultured VX2 Cells
Published on: September 12, 2019
Resultados de Supervivencia Después de Cirugía Inadvertida en Cáncer de Cuello Uterino en Etapa Temprana de Bajo
Nuria Agustí1, David Viveros-Carreño2, Chi-Fang Wu3
1Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Background:
Recent randomized de-escalation trials have shown that planned simple hysterectomy with lymph node assessment provides outcomes comparable to radical hysterectomy in selected patients with early-stage cervical cancer (tumors ≤2 cm, limited stromal invasion). However, whether these favorable outcomes extend to patients who undergo inadvertent simple hysterectomy-performed without oncologic surgical planning due to diagnostic or treatment pathway failures-remains unknown.
Objective:
To evaluate whether patients with early-stage cervical cancer (tumors ≤2 cm) who underwent inadvertent surgery have similar overall survival (OS) compared with those treated with planned oncologic surgery. We also assessed whether salvage adjuvant therapy in this setting shows a survival benefit over observation.
Study Design:
This cohort study used data from the U.S. National Cancer Database (2010-2020) to identify patients with early-stage cervical cancer (≤2 cm) who underwent either planned oncologic surgery or inadvertent surgery (simple hysterectomy without nodal staging), including women with an inadvertent diagnosis or those inadequately treated for previously known in situ or microinvasive disease. Missing data were handled through multiple imputation. Inverse probability of treatment weighting (IPTW) balanced covariates across groups. OS was analyzed using IPTW-adjusted Kaplan-Meier curves and Cox proportional hazards models. Subgroup analyses assessed effect modification. IPTW was reapplied within the inadvertent surgery cohort to compare OS by salvage adjuvant therapy receipt.
Results:
Among 5,608 eligible patients, 688 (12.3%) underwent inadvertent surgery, including 258 with an inadvertent diagnosis and 430 with a known diagnosis but inadequate surgical treatment, while 4,920 (87.7%) received planned oncologic surgery. After IPTW adjustment, patients in the inadvertent surgery cohort had significantly lower 5-year OS (91.5% vs 96.2%; hazard ratio [HR], 1.89; 95% CI, 1.42-2.52; P < .001). Adjuvant (chemo)radiotherapy was more common after inadvertent surgery (29.1% vs 11.3%, p=0.035). Among these patients, salvage adjuvant (chemo)radiotherapy did not significantly improve OS when compared with observation (HR, 1.33; 95% CI, 0.59-3.00; P = .5).
Conclusions:
In patients with low-risk, early-stage cervical cancer, inadvertent surgery was associated with a survival disadvantage. Salvage adjuvant (chemo)radiotherapy failed to overcome this disadvantage, underscoring the importance of appropriate oncologic surgical planning and referral.
