Survival effect of laparoscopic para‐aortic staging in locally advanced cervical cancer: a retrospective cohort analysis

Pomel, Christophe; Martinez, Alejandra; Bourgin, Charlotte; Béguinot, Marie; Benoit, C; Naik, Rakhi P.; Dauplat, J.; Lebouedec, Guillaume; Ferron, Gwénaël

doi:10.1111/1471-0528.14492

Cited by 22 publications

(14 citation statements)

References 23 publications

(24 reference statements)

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“…In three studies, 132 patients underwent aortic LND, and metastases were present in 44 patients (33%) [ 5 6 7 18 ]. Two studies reported percentages of pelvic LN metastasis while one study reported neither pelvic nor aortic LN status ( Table 3 ) [ 6 8 18 ].…”

Section: Resultsmentioning

confidence: 99%

“…Hazard ratios for survival were reported in four of the five studies ( Table 4 Fig. 2 ) [ 6 7 8 18 ]. After compilation of data, meta-analysis determined comparable PFS (HR=1.13; 95% CI=0.73–1.74; I 2 =75%; p<0.01) and OS (HR=1.06; 95% CI=0.66–1.69; I 2 =75%; p<0.01) between surgical and imaging nodal assessment ( Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Lymph node (LN) metastases can be assessed using imaging with or without pathologic confirmation, and nodal status largely dictates radiotherapy (RT) dose and field [ 3 4 ]. However, approach to pre-therapy LN assessment in patients with locally advanced cervical cancer is debatable [ 5 6 7 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Aortic lymphadenectomy (LND) with or without pelvic LND was gold standard in earlier practices and used as criterium for enrollment into clinical trials [ 9 ]. Some literature suggests LND has therapeutic benefit and impacts survival in advanced-stage cervical cancer patients [ 7 ]. However, LND requires advanced surgical skills and increases risk for complications, potentially delaying initiation of chemoradiation.…”

Section: Introductionmentioning

confidence: 99%

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Surgical or imaging lymph node assessment in locally advanced cervical cancer: a systematic review and meta-analysis

et al. 2020

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Objective To evaluate the survival impact of imaging vs surgical nodal assessment in patients with cervical cancer stage IB2–IVA prior to definitive chemoradiotherapy (CRT). Methods PubMed, MEDLINE, Cochrane Library, and ClinicalTrials.gov were used to search for publications in English and Chinese over a 50-year period. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols was used to conduct this review. Inclusion criteria were studies that compared survival outcomes in International Federation of Gynecology and Obstetrics 2009 stage IB2–IVA cervical cancer patients with pre-therapy pelvic and/or aortic lymphadenectomy (LND) or imaging. One or more of the following modalities were used for nodal assessment: computed tomography (CT), magnetic resonance imaging, or positron emission tomography-CT. The National Institutes of Health Quality Assessment Tool was utilized to assess study quality. Results The initial search identified 65 studies, and five met the inclusion criteria. There were a total of 1,112 patients. Seven hundred and fifty-four underwent pelvic and/or aortic LND and 358 had imaging. When compared to LND, imaging had a sensitivity and specificity of 88.9% and 22.2% for pelvic lymph node (LN), and 33%–62.5% and 92%–95.5% for para-aortic LN. There were no differences in progression-free survival (PFS) (hazard ratio [HR]=1.13; 95% confidence interval [CI]=0.73–1.74; I 2 =75%; p<0.01) and overall survival (OS) (HR=1.06; 95% CI=0.66–1.69; I 2 =75%; p<0.01) between surgical and imaging nodal assessment. Conclusions Imaging and surgical nodal assessment has comparable PFS and OS in patients with cervical cancer stage IB2–IVA. Trial Registration PROSPERO Identifier: CRD42020155486

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical or imaging lymph node assessment in locally advanced cervical cancer: a systematic review and meta-analysis

et al. 2020

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“…The decision of whether to apply extended radiation fields was thus not based on the results of the surgical staging. As mentioned by Pomel et al [ 18 ], no study has shown a clear benefit of extended field radiotherapy on survival following the introduction of cisplatin systemic therapy in the initial management of patients with LACC [ 19 ]. The benefit of surgical staging in patients with negative preoperative workup seems to be independent of the extent of the radiation fields.…”

Section: Discussionmentioning

confidence: 99%

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

Dabi¹,

Simon²,

Carcopino³

et al. 2018

J Transl Med

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BackgroundThe 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.MethodsData 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.ResultsSix 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).ConclusionNodal surgical staging had an independent positive impact on survival in patients with LACC treated with CRT with no evidence of metastatic PALN on imaging.Electronic supplementary materialThe online version of this article (10.1186/s12967-018-1703-4) contains supplementary material, which is available to authorized users.

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Tumour and pelvic lymph node metabolic activity on FDG-PET/CT to stratify patients for para-aortic surgical staging in locally advanced cervical cancer

Martinez

Voglimacci

Lusque

et al. 2020

Eur J Nucl Med Mol Imaging

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Survival effect of laparoscopic para‐aortic staging in locally advanced cervical cancer: a retrospective cohort analysis

Abstract: Para-aortic surgical staging in LACC is more deleterious for patients than clinical staging.

Cited by 22 publications

References 23 publications

Surgical or imaging lymph node assessment in locally advanced cervical cancer: a systematic review and meta-analysis

Surgical or imaging lymph node assessment in locally advanced cervical cancer: a systematic review and meta-analysis

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

Tumour and pelvic lymph node metabolic activity on FDG-PET/CT to stratify patients for para-aortic surgical staging in locally advanced cervical cancer

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