Impact of surgical para-aortic lymph node staging for patients with advanced-stage cervical carcinoma undergoing definitive chemoradiation

Abstract

<h3>Objectives:</h3> Evaluate the utilization and impact of surgical para-aortic surgical staging on the survival of patients with locally advanced-stage cervical carcinoma receiving definitive chemoradiation. <h3>Methods:</h3> Patients diagnosed between 2004-2015 with advanced stage (IIA-IVA) squamous, adenocarcinoma, adenosquamous carcinoma of the cervix with no distant metastases who did not undergo hysterectomy and received primary chemoradiation (external beam with or without brachytherapy) with at least one month of follow-up were identified in the National Cancer Database. Two groups were formed based on the assessment method of the para-aortic lymph node status; radiologic assessment versus surgical lymphadenectomy (PaLND). Overall survival was compared with the log-rank test following generation of Kaplan-Meier curves and a Cox multivariate model was constructed to control for a priori selected confounders. <h3>Results:</h3> A total of 3610 patients who met the inclusion criteria were identified. Surgical para-aortic staging was performed for 287 (8%) patients. Patients who had PaLND were younger (median 49 vs 53 years, p<0.001) more likely to have private insurance (49.1% vs 35.2%, p<0.001), or stage II disease (63.4% vs 56.3%, p=0.019), and receive brachytherapy (74.2% vs 66.9%, p<0.001). Patients who underwent PaLND were also more likely to have LNs categorized as positive (16.1% vs 11.2%, p=0.014). There was no difference in OS between patients who underwent primary radiologic vs primary surgical para-aortic LN assessment, p=0.42; 5-year OS rates were 55.6% for both groups. After controlling for patient age, race, insurance status, stage, histology, presence of comorbidities, history of another tumor, and receipt of brachytherapy, performance of PaLND was not associated with a survival benefit (HR: 1.05, 95% CI: 0.86, 1.29). <h3>Conclusions:</h3> In a large cohort of patients with locally advanced stage cervical carcinoma, undergoing primary chemoradiation, staging PaLND was rarely performed and not associated with a survival benefit.