Patterns of First Recurrence and Oncological Outcomes in Locally Advanced Cervical Cancer Patients : Does Surgical Staging Play a Role?
Bebia, Vicente (Hospital Universitari Vall d'Hebron)
Díaz-Feijoo, Berta (Hospital Clínic i Provincial de Barcelona)
Tejerizo, Álvaro (Hospital 12 de Octubre (Madrid))
Torne, Aureli (Hospital Clínic i Provincial de Barcelona)
Benito, Virginia (Complejo Hospitalario Universitario Insular-Materno Infantil)
Hernández Gutierrez, Alicia (Hospital Universitario La Paz (Madrid))
Gorostidi, Mikel (Hospital Universitario Donostia)
Domingo, Santiago (Hospital Universitari i Politècnic La Fe)
Bradbury, Melissa (Hospital Universitari Vall d'Hebron)
Luna-Guibourg, Rocío (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Gil-Moreno, Antonio 1965- (Hospital Universitari Vall d'Hebron)
Universitat Autònoma de Barcelona

Fecha:	2024
Resumen:	Whenever cancer of the uterine cervix is diagnosed in a locally advanced stage, it is important to know whether it affects the lymph nodes above the pelvis or not. There are two ways of ruling it out: by a surgery, called paraaortic lymphadenectomy, or by imaging tests. With this study, we wanted to see whether paraaortic lymphadenectomy affected the natural evolution of the tumor by looking at the differences in the recurrence rate between both groups. We used a statistical technique that makes both groups comparable. We observed that patients who underwent a paraaortic surgery suffered more recurrences (both at the lymph nodes and at distance) and survived less than those treated only with the information from the imaging tests. We aimed to determine whether surgical aortic staging by minimally invasive paraaortic lymphadenectomy (PALND) affects the pattern of first recurrence and survival in treated locally advanced cervical cancer (LACC) patients when compared to patients staged by imaging (noPALND). This study was a multicenter observational retrospective cohort study of patients with LACC treated at tertiary care hospitals throughout Spain. The inclusion criteria were histological diagnosis of squamous carcinoma, adenosquamous carcinoma, and/or adenocarcinoma; FIGO stages IB2, IIA2-IVA (FIGO 2009); and planned treatment with primary chemoradiotherapy between 2000 and 2016. Propensity score matching (PSM) was performed before the analysis. After PSM and sample replacement, 1092 patients were included for analysis (noPALND n = 546, PALND n = 546). Twenty-one percent of patients recurred during follow-up, with the PALND group having almost double the recurrences of the noPALND group (noPALND: 15. 0%, PALND: 28. 0%, p < 0. 001). Nodal (regional) recurrences were more frequently observed in PALND patients (noPALND:2. 4%, PALND: 11. 2%, p < 0. 001). Among those who recurred regionally, 57. 1% recurred at the pelvic nodes, 37. 1% recurred at the aortic nodes, and 5. 7% recurred simultaneously at both the pelvic and aortic nodes. Patients who underwent a staging PALND were more frequently diagnosed with a distant recurrence (noPALND: 7. 0%, PALND: 15. 6%, p < 0. 001). PALND patients presented poorer overall, cancer-specific, and disease-free survival when compared to patients in the noPALND group. After treatment, surgically staged patients with LACC recurred more frequently and showed worse survival rates.
Derechos:	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, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Aortic lymphadenectomy ; Cervical cancer ; Surgical staging
Publicado en:	Cancers, Vol. 16 (april 2024) , ISSN 2072-6694

DOI: 10.3390/cancers16071423
PMID: 38611101

11 p, 1.2 MB

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