The extent of aortic lymphadenectomy in locally advanced cervical cancer impacts on survival
Llueca, Antoni (Consorci Hospitalari Provincial de Castelló)
Escrig, Javier (Consorci Hospitalari Provincial de Castelló)
Gil-Moreno, Antonio 1965- (Hospital Universitari Vall d'Hebron)
Benito, Virginia (Complejo Hospitalario Materno Insular de Gran Canaria (Las Palmas de Gran Canaria))
Hernández Gutierrez, Alicia (Hospital Universitario La Paz (Madrid))
Díaz-Feijoo, Berta (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Universitat Autònoma de Barcelona

Data:	2020
Resum:	The prognostic impact of surgical paraaortic staging remains unclear in patients with locally advanced cervical cancer (LACC). The objective of our study was to evaluate the results of the surgical technique of preoperative aortic lymphadenectomy in LACC related to tumor burden and disease spread to assess its influence on survival. Data of 1,072 patients with cervical cancer were taken from 11 Spanish hospitals (Spain-Gynecologic Oncology Group [GOG] working group). Complete aortic lymphadenectomy surgery (CALS) was considered when the lymph nodes (LNs) were excised up to the left renal vein. The extent of the disease was performed evaluating the LNs by calculating the geometric means and quantifying the log odds between positive LNs and negative LNs. The Kaplan-Meier method was used to estimate the survival distribution. A Cox proportional hazards model was used to account for the influence of multiple variables. A total of 394 patients were included. Pathological analysis revealed positive aortic LNs in 119 patients (30%). LODDS cut-off value of −2 was established as a prognostic indicator. CALS and LODDS <−2 were associated with better disease free survival and overall survival than suboptimal aortic lymphadenectomy surgery and LODDS ≥−2. In a multivariate model analysis, CALS is revealed as an independent prognostic factor in LACC. When performing preoperative surgical staging in LACC, it is not advisable to take simple samples from the regional nodes. Radical dissection of the aortic and pelvic regions offers a more reliable staging of the LNs and has a favorable influence on survival.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Cervical Cancer ; Survival Rate ; Disease-Free Survival ; Lymph Node Excision ; Lymphatic Metastasis
Publicat a:	Journal of Gynecologic Oncology, Vol. 32 (october 2020) , ISSN 2005-0399

DOI: 10.3802/jgo.2021.32.e4
PMID: 33185045

12 p, 2.0 MB

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