Abstract
Objective:Surgical staging was recently recommended for the decision of treatment in locally advanced cervical cancer. We aimed to investigate clinical outcomes as well as factors associated with overall survival (OS) in patients with locally advanced cervical cancer who had undergone extraperitoneal lymph node dissection and were managed according to their lymph node status.Material and Methods:The medical records of 233 women with stage IIb-IVa cervical cancer who were clinically staged and underwent extraperitoneal lymph node dissection were retrospectively reviewed. Paraaortic lymph node status determined the appropriate radiotherapeutic treatment field. Surgery-related complications and clinical outcomes were evaluated.Results:The median age of the patients was 52 years (range, 26-88 years) and the median follow-up time was 28.4 months (range, 3-141 months). Thirty-one patients had laparoscopic extraperitoneal lymph node dissection and 202 patients underwent laparotomy. The number of paraaortic lymph nodes extracted was similar for both techniques. Sixty-two (27%) of the 233 patients had paraaortic lymph node metastases. The 3-year and 5-year OS rates were 55.1% and 46.5%, respectively. The stage of disease, number of metastatic paraaortic lymph nodes, tumor type, and paraaortic lymph node status were associated with OS. In multivariate Cox regression analyses, tumor type, stage, and presence of paraaortic lymph node metastases were the independent prognostic factors of OS.Conclusion:Paraaortic lymph node metastasis is the most important prognostic factor affecting survival. Surgery would give hints about the prognosis and treatment planning of the patient.
Highlights
Cervical cancer is a major health problem worldwide and the most common cause of cancer-related death in women from developing countries
Based on the finding of better prognosis in patients who underwent surgical exclusion of paraaortic lymph node involvement compared with radiologically determined lymph node involvement, the importance of lymph node status affecting prognosis in locally advanced cervical cancer is emphasized in the current staging system of cervical cancer [7]
Paraaortic metastasis upgrades the stage to IVb (FIGO staging), which previously did not exist in the clinical staging system [1]
Summary
Cervical cancer is a major health problem worldwide and the most common cause of cancer-related death in women from developing countries. Survival and management of cervical cancer depends on the stage of the disease, which is determined by the principles of the International Federation of Gynecology and Obstetrics (FIGO) revised in 2009 [1]. Five-year survival rates achieve 88-100% in stage Ia-b disease, whereas in advanced stage, it barely reaches 50%. Inaccuracy of clinical staging, which reaches 50-56%, makes pre-treatment nodal staging and future research about the topic more important [2]. With the additional finding of lymph node involvement as the most important prognostic factor for cervical cancer, assessment of lymphatic involvement has gained greater importance. Surgical evaluation of lymph nodes is a reliable method and may be performed either transperitoneally or extraperitoneally. Surgical staging of cervical cancer has been implemented commonly since the 1990s when the extraperitoneal technique
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