Completion of radical hysterectomy does not improve survival of patients with cervical cancer and intraoperatively detected lymph node involvement: ABRAX international retrospective cohort study
Autor: | A. Jaeger, Giovanni Scambia, G. Scibilia, Francesco Raspagliesi, L Dostalek, Ignace Vergote, Rene Pareja, David Cibula, J. Klat, D. Isla-Ortiz, I. Runnenbaum, S. Laufhutte, Aldo Lopez, R.L. Schmidt, A. El-Balat, T. Toptas, V. Weinberger, Peter Hillemanns, Jiri Jarkovsky, M.E. Capilna, A. Kucukmetin, Jan Persson, L. Kreitner, Z. Novak, B. Gil-Ibanez, G.J.R. Pereira |
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Rok vydání: | 2021 |
Předmět: |
Adult
0301 basic medicine Cancer Research medicine.medical_specialty Uterine Cervical Neoplasms Hysterectomy Cohort Studies 03 medical and health sciences 0302 clinical medicine medicine Humans Stage (cooking) Radical Hysterectomy Lymph node Aged Retrospective Studies Cervical cancer business.industry Hazard ratio Retrospective cohort study Middle Aged medicine.disease Survival Analysis 3. Good health Surgery Dissection 030104 developmental biology medicine.anatomical_structure Oncology 030220 oncology & carcinogenesis Cohort Female business |
Zdroj: | European Journal of Cancer. 143:88-100 |
ISSN: | 0959-8049 |
Popis: | Background The management of cervical cancer patients with intraoperative detection of lymph node involvement remains controversial. Since all these patients are referred for (chemo)radiation after the surgery, the key decision is whether radical hysterectomy should be completed as originally planned, taking into account an additional morbidity associated with extensive surgical dissection prior to adjuvant treatment. The ABRAX study investigated whether completing a radical uterine procedure is associated with an improved oncological outcome of such patients. Patients and methods We performed retrospective analyses of 515 cervical cancer patients (51 institutions, 19 countries) who were referred for primary curative surgery between 2005 and 2015 (stage IA–IIB, common tumour types) in whom lymph node involvement was detected intraoperatively. Patients were stratified according to whether the planned uterine surgery was completed (COMPL group, N = 361) or abandoned (ABAND group, N = 154) to compare progression-free survival. Definitive chemoradiation was given to 92.9% patients in the ABAND group and adjuvant (chemo)radiation or chemotherapy to 91.4% of patients in the COMPL group. Results The risks of recurrence (hazard ratio [HR] 1.154, 95% confidence intervals [CI] 0.799–1.666, P = 0.45), pelvic recurrence (HR 0.836, 95% CI 0.458–1.523, P = 0.56), or death (HR 1.064, 95% CI 0.690–1.641, P = 0.78) were not significantly different between the two groups. No subgroup showed a survival benefit from completing radical hysterectomy. Disease-free survival reached 74% (381/515), with a median follow-up of 58 months. Prognostic factors were balanced between the two groups. FIGO stage and number of pelvic lymph nodes involved were significant prognostic factors in the whole study cohort. Conclusion We showed that the completion of radical hysterectomy does not improve survival in patients with intraoperatively detected lymph node involvement, regardless of tumour size or histological type. If lymph node involvement is confirmed intraoperatively, abandoning uterine radical procedure should be considered, and the patient should be referred for definitive chemoradiation. Clinical trials identifier NCT04037124 . |
Databáze: | OpenAIRE |
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