Completing or Abandoning Radical Hysterectomy in Early-Stage Lymph Node–Positive Cervical Cancer

Derks, Marloes; Groenman, Freek; Lonkhuijzen, Luc van; Schut, Paulien C.; Westerveld, Henrike; Velden, J. van der; Kenter, Gemma G.

doi:10.1097/igc.0000000000000974

Cited by 19 publications

(18 citation statements)

References 25 publications

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“…The largest study included in the Surveillance, Epidemiology, and End Results (SEER) database shows that RH (followed by adjuvant RT) for patients with pelvic node‐positive disease does not benefit DFS and OS compared with RT 9 . In contrast, several studies found that RH may provide better pelvic control 10,11 . Although there was not patient with pelvic recurrences in the RH group, a higher overall recurrence rate was observed in the present study.…”

Section: Discussioncontrasting

confidence: 70%

Treatment strategy for locally advanced squamous cell cervical cancer with clinically positive pelvic lymph nodes metastasis

Shibutani

Nagao

Suzuki

et al. 2021

J of Obstet and Gynaecol

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Aim To determine the optimal treatment for locally advanced squamous cell cervical cancer with clinical positive pelvic lymph nodes metastasis (cN1). Methods We enrolled patients with squamous cell cervical cancer with 2008 FIGO stages IB, IIA, or IIB diagnosed with cN1, who were treated at Hyogo Cancer Center between April 2010 and December 2016. Patients with para‐aortic lymph nodes metastasis were excluded. Results Of the 69 eligible patients, 24 underwent concurrent chemoradiotherapy (CCRT), 11 underwent radical hysterectomy with pelvic lymphadenectomy (RH) with or without adjuvant RT, and 34 underwent neoadjuvant chemotherapy (NAC) followed by RH as initial treatment. The regimens of NAC included dose‐dense TC (paclitaxel 80 mg/m2, days 1, 8, 15; and carboplatin at an area under the curve = 6 on day 1, every 3 weeks) and dose‐dense TP (paclitaxel 80 mg/m2 on days 1, 8, 15; and cisplatin 75 mg/m2 on day 1, every 3 weeks). The median observation period was 57 (12–107) months. The 5‐year disease‐free survival rates of the CCRT, RH, and NAC groups were 78.7%, 63.6%, and 88.2%, respectively (p = 0.14). The 5‐year overall survival rates of the CCRT, RH, and NAC groups were 78.6%, 70.1%, and 94.1%, respectively (p = 0.11). Conclusions We recommend avoiding RH as primary treatment for cN1 with locally advanced squamous cell cervical cancer. Although CCRT should be considered for cN1, further studies are required to determine if NAC followed by RH will serve as an effective option.

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Section: Discussioncontrasting

confidence: 70%

Treatment strategy for locally advanced squamous cell cervical cancer with clinically positive pelvic lymph nodes metastasis

Shibutani

Nagao

Suzuki

et al. 2021

J of Obstet and Gynaecol

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“…More grade 3e4 complications were reported in the abandoned group (47% vs. 27% of cases), which the authors hypothesised to be due to increased radiation exposure [15]. In the most recent study, the authors compared the outcomes of 121 patients who underwent primary surgery in a 10-year period at two sites in Amsterdam [20]. Patients with intraoperatively detected lymph node involvement, in whom radical hysterectomy was aborted, were compared with patients whose procedure was completed and lymph node involvement detected by final pathology.…”

Section: Discussionmentioning

confidence: 99%

Completion of radical hysterectomy does not improve survival of patients with cervical cancer and intraoperatively detected lymph node involvement: ABRAX international retrospective cohort study

Cibula

Dostálek

Hillemanns

et al. 2021

European Journal of Cancer

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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 IAeIIB, 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 Z 361) or abandoned (ABAND group, N Z 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 e1.666, P Z 0.45), pelvic recurrence (HR 0.836, 95% CI 0.458e1.523, P Z 0.56), or death (HR 1.064, 95% CI 0.690e1.641, P Z 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.

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“…With the discovery of multiple cervical cancer bio-markers, cervical cancer can be detected and treated early, and the incidence and mortality of cervical cancer have been significantly reduced [3, 4]. At present, the treatment of cervical cancer mainly focuses on surgery and radiotherapy, but the survival rates of patients with advanced stage is very low, and the 5-year survival rates of invasive cervical cancer is only 67% [5, 6]. Additionally, early cervical cancer has no obvious symptoms, which therefore increases the difficulty of diagnosis [7].…”

Section: Introductionmentioning

confidence: 99%

SMYD2 promotes cervical cancer growth by stimulating cell proliferation

Sun

et al. 2019

Cell Biosci

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Background Cervical cancer is the most common gynecological malignancy with low terminal cure rate, and therefore new therapeutic targets are urgently needed to combat this disease. SMYD2, as an oncogene, is abnormal highly expressed in multiple types of tumors and further affects the occurrence and development, but the potential correlations between SMYD2 expression and cervical cancer progression is still unclear. Methods We first used the bioinformatics website to screen the data of cervical cancer in (The Cancer Genome Atlas) TCGA and survival analysis was used to find the different survival rates in the SMYD2 high expression group and low expression group. Through immunohistochemistry, the association between SMYD2 expression and clinical-pathological features of cervical cancer patients was further evaluated. Quantitative PCR and Immunoblot were applied to investigate the relative mRNA and protein expression levels, respectively. In vivo and in vitro experiments were performed to explore the function of SMYD2 in cancer progression. Results We first found a high expression of SMYD2 in cervical cancer, and survival analysis found that the poorer survival rate in the SMYD2 high expression group than that in the low expression group. Herein, our study demonstrated that the expression of SMYD2 in patients with cervical cancer was associated with FIGO stage, tumor size and further correlated with poor prognosis. Our data further showed that the inhibition of SMYD2 expression in cervical cancer cell line Caski and Siha could dramatically block the proliferation of cervical cancer cells. Additionally, SMYD2-shRNA lentivirus infected remarkably inhibited tumorigenesis in mice compared with the scramble group. Conclusions Taken together, this study provides strong evidence of the involvement of SMYD2 in cervical cancer growth and indicates that it could have high potential as a therapeutic target of cervical cancer.

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Completing or Abandoning Radical Hysterectomy in Early-Stage Lymph Node–Positive Cervical Cancer

Cited by 19 publications

References 25 publications

Treatment strategy for locally advanced squamous cell cervical cancer with clinically positive pelvic lymph nodes metastasis

Treatment strategy for locally advanced squamous cell cervical cancer with clinically positive pelvic lymph nodes metastasis

Completion of radical hysterectomy does not improve survival of patients with cervical cancer and intraoperatively detected lymph node involvement: ABRAX international retrospective cohort study

SMYD2 promotes cervical cancer growth by stimulating cell proliferation

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