Therapeutic value of surgical paraaortic staging in locally advanced cervical cancer: a multicenter cohort analysis from the FRANCOGYN study group

• DOI: 10.1186/s12967-018-1703-4
• Publication Date: 2018-11-26T05:01:55Z
• Authors: Yohann Dabi; Vanille Simon; Xavier Carcopino; Sofiane Bendifallah; Lobna Ouldamer; Vincent Lavoue; Geoffroy Canlorbe; Emilie Raimond; Charles Coutant; Olivier Graesslin; Pierre Collinet; Alexandre Bricou; Emile Daraï; Cyrille Huchon; Marcos Ballester; Bassam Haddad; Cyril Touboul
• Keywords: Adult; [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery; 610; Uterine Cervical Neoplasms; [SDV.CAN]Life Sciences [q-bio]/Cancer; Paraaortic lymph nodes invasion; [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery; Kaplan-Meier Estimate; [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics; Disease-Free Survival; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; [SDV.CAN] Life Sciences [q-bio]/Cancer; Humans; Nodal surgical staging; Neoplasm Staging; Proportional Hazards Models; Locally advanced cervical cancer; Research; R; Middle Aged; 3. Good health; [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics; Multivariate Analysis; Cervical cancer; Medicine; Female

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 survival impact of surgical staging in patients with LACC and no evidence of paraaortic lymph node (PALN) metastasis on pre-operative imaging work-up.Data of 1447 patients with cervical cancer treated between 1996 and 2016 were extracted from maintained databases of 10 French University hospitals. Patients with locally advanced disease (IB2 or more) treated by concurrent chemoradiation therapy (CRT) and no evidence of paraaortic metastasis on pre-operative imaging work-up were selected for further analysis. 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.Six hundred and forty-seven patients were included, 377 (58.3%) with surgical staging and 270 (41.7%) without, with a mean follow up of 38.1 months (QI 13.0-56.0). Pathologic analysis revealed positive lymph nodes in 47 patients (12.5%). In multivariate model analysis, surgical staging remained an independent prognostic factor for DFS (OR 0.64, CI 95% 0.46-0.89, p = 0.008) and OS (OR 0.43, CI 95% 0.27-0.68, p < 0.001). The other significant parameter in multivariate analysis for both DFS and OS was treatment by intracavitary brachytherapy (OR respectively of 0.7 (0.5-1.0) and 0.6 (0.4-0.9), p < 0.05).Nodal surgical staging had an independent positive impact on survival in patients with LACC treated with CRT with no evidence of metastatic PALN on imaging.