Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
Gynecologic Oncology Department, National Cancer Institute, Bogota, Colombia.
Gynecol Oncol. 2018 Sep;150(3):406-411. doi: 10.1016/j.ygyno.2018.07.010. Epub 2018 Jul 17.
To investigate the utility of para-aortic lymph node dissection among women undergoing radical hysterectomy and pelvic lymph adenectomy for FIGO Stage IA2-IB2 cervical cancer using the National Cancer Database (NCDB).
We identified patients with stage IA2-IB2 squamous cell, adenosquamous, or adenocarcinoma of the cervix diagnosed 2011-2014 in the NCDB. The primary outcome was the negative predictive value of histologically assessed pelvic lymph node status for para-aortic lymph node status among women undergoing pelvic and para-aortic lymph node dissection. We calculated probability of para-aortic lymph node metastasis conditional on pelvic lymph node status. Finally, we compared overall survival between patients undergoing para-aortic lymph node dissection and those in whom this procedure was omitted.
A total of 3212 patients met study inclusion criteria, of whom 994 (30.9%) underwent para-aortic lymph node dissection. In this group, the risk of isolated para-aortic metastasis was 0.11%. The negative predictive value of surgically assessed pelvic lymph nodes to predict para-aortic lymph node status was 99.9% (95% CI 99.9-99.9). Among 93 patients with pelvic lymph node metastasis, 18 (19.4%) had concurrent para-aortic lymph node metastasis. There was no difference in overall survival between women undergoing pelvic and para-aortic lymph node dissection compared with those undergoing pelvic lymphadenectomy only (p = 0.69).
In patients undergoing radical hysterectomy and pelvic lymphadenectomy for stage IA2-IB2 cervical cancer, para-aortic lymph node dissection is not warranted based on the low risk of isolated metastatic disease, and lack of survival benefit associated with the procedure.
利用国家癌症数据库（NCDB）调查在行根治性子宫切除术和盆腔淋巴结切除术的 FIGO 分期 IA2-IB2 宫颈癌患者中进行腹主动脉旁淋巴结清扫的效用。
我们在 NCDB 中确定了 2011 年至 2014 年间诊断为 IA2-IB2 期宫颈鳞癌、腺鳞癌或腺癌的患者。主要结局是行盆腔和腹主动脉旁淋巴结清扫术的女性中，组织学评估的盆腔淋巴结状态对腹主动脉旁淋巴结状态的阴性预测值。我们计算了在盆腔淋巴结状态的条件下腹主动脉旁淋巴结转移的概率。最后，我们比较了行腹主动脉旁淋巴结清扫术和未行该手术的患者的总生存率。
共有 3212 名患者符合研究纳入标准，其中 994 名（30.9%）行腹主动脉旁淋巴结清扫术。在此组中，孤立性腹主动脉旁转移的风险为 0.11%。手术评估的盆腔淋巴结对预测腹主动脉旁淋巴结状态的阴性预测值为 99.9%（95%CI 99.9-99.9）。在 93 名盆腔淋巴结转移的患者中，18 名（19.4%）存在同期腹主动脉旁淋巴结转移。与仅行盆腔淋巴结清扫术的患者相比，行盆腔和腹主动脉旁淋巴结清扫术的患者的总生存率无差异（p=0.69）。
在接受根治性子宫切除术和盆腔淋巴结切除术的 IA2-IB2 期宫颈癌患者中，根据孤立性转移性疾病的低风险和与该手术相关的生存获益缺乏，不推荐行腹主动脉旁淋巴结清扫术。
