Comparison of survival outcomes with or without Para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer in China from 2004 to 2016

Chunlin Chen,Wenling Zhang,Jinghe Lang,Yan Ni,Ping Liu,Huijian Fan,Hui Duan,Xiaonong Bin,Donglin Li,Hongwei Zhao,Jiaming Chen,Weidong Zhao,Shan Kang,Lihong Lin,Li Wang,Xiaolin Chen

doi:10.1186/s12885-021-08797-2

Abstract

BackgroundCurrent opinions on whether surgical patients with cervical cancer should undergo para-aortic lymphadenectomy at the same time are inconsistent. The present study examined differences in survival outcomes with or without para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer.MethodsWe retrospectively compared the survival outcomes of 8802 stage IB1-IIA2 cervical cancer patients (FIGO 2009) who underwent abdominal radical hysterectomy + pelvic lymphadenectomy (n = 8445) or abdominal radical hysterectomy + pelvic lymphadenectomy + para-aortic lymphadenectomy (n = 357) from 37 hospitals in mainland China.ResultsAmong the 8802 patients with stage IB1-IIA2 cervical cancer, 1618 (18.38%) patients had postoperative pelvic lymph node metastases, and 37 (10.36%) patients had para-aortic lymph node metastasis. When pelvic lymph nodes had metastases, the para-aortic lymph node simultaneous metastasis rate was 30.00% (36/120). The risk of isolated para-aortic lymph node metastasis was 0.42% (1/237). There were no significant differences in the survival outcomes between the para-aortic lymph node unresected and resected groups. No differences in the survival outcomes were found before or after matching between the two groups regardless of pelvic lymph node negativity/positivity.ConclusionPara-aortic lymphadenectomy did not improve 5-year survival outcomes in surgical patients with stage IB1-IIA2 cervical cancer. Therefore, when pelvic lymph node metastasis is negative, the risk of isolated para-aortic lymph node metastasis is very low, and para-aortic lymphadenectomy is not recommended. When pelvic lymph node metastasis is positive, para-aortic lymphadenectomy should be carefully selected because of the high risk of this procedure.

Highlights

Cervical cancer ranks fourth for incidence and mortality in females [1]
Hackett TE et al [6] suggested that surgical patients with cervical cancer stage IA2-IIA undergo para-aortic lymphadenectomy (PAL) when pelvic lymph node (PLN) or para-aortic lymph node (PALN) is suspected of metastasis
The Cox multivariate analysis showed that PALN resection was not an independent factor (HR = 1.124; 95% confidence intervals (CIs), 0.849– 1.489; p = 0.413)

Summary

Introduction

Cervical cancer ranks fourth for incidence and mortality in females [1]. it is of great importance to optimize individual treatments for cervical cancer. Using the National Cancer Database, Del Carmen et al [3] included 3212 surgical patients with stage IA2-IB2 cervical cancer and found no statistically significant difference in the 3-year survival rates between pelvic lymph node (PLN) + para-aortic lymph node (PALN) resection and PLN resection alone (p = 0.69). Tsuruga et al [4] showed that PAL did not positively impact the 5-year survival rate in 308 patients. Hackett TE et al [6] suggested that surgical patients with cervical cancer stage IA2-IIA undergo PAL when PLN or PALN is suspected of metastasis. Current opinions on whether surgical patients with cervical cancer should undergo para-aortic lymphadenectomy at the same time are inconsistent. The present study examined differences in survival outcomes with or without para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer

Methods

Results

Discussion

Conclusion