Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America.
Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America.
Gynecol Oncol. 2023 Mar;170:248-253. doi: 10.1016/j.ygyno.2023.01.031. Epub 2023 Feb 2.
Surgical evaluation of lymph node metastasis is paramount in the treatment of cervical cancer. We sought to explore the outcomes of patients with and without para-aortic lymphadenectomy undergoing curative-intent radical hysterectomy for stage IA-IIA cervical cancer.
Institutional data were retrospectively reviewed to identify women undergoing curative-intent radical hysterectomy with concurrent lymphadenectomy for stage IA-IIA cervical carcinoma from 2004 to 2021. Any carcinoma histology was allowed. Clinical risk stratification was performed according to GOG 92 and GOG 109 protocols. Disease outcomes, patterns of recurrence, and survival were analyzed with Chi square, t-test, Kaplan-Meier, and Cox proportional hazards multivariable statistics.
300 patients were identified, 265 met inclusion criteria. Median follow up was 56 months. Pelvic lymphadenectomy (PLND) was performed in 71%, with the remainder undergoing combined para-aortic dissection (PPaLND). Baseline patient demographics and presence of clinical risk factors were well balanced between groups. PPaLND was more common in patients undergoing open surgery (OR 10.58, p <.0001), and tumors were larger in this group (2.96 vs 2.12 cm, p = .0002) and more likely non-squamous histology (OR 2.02, p = .017). Recurrence of disease was present in 13% of cases, with no difference between PLND and PPaLND regardless of histology. There were zero cases of isolated PaLN recurrence in either group. Neither progression free nor overall survival was different between groups. Prophylactic extended field radiation (EFRT) was not prescribed.
Omission of PaLN dissection, in the absence of suspicious nodes, did not decrease survival. There were no isolated PaLN recurrences after PLND alone.
在宫颈癌的治疗中，淋巴结转移的外科评估至关重要。我们旨在探讨行根治性子宫切除术治疗 IA-IIA 期宫颈癌时行与不行腹主动脉旁淋巴结切除术患者的结局。
回顾性分析 2004 年至 2021 年期间机构数据，确定接受根治性子宫切除术+同期淋巴结切除术治疗 IA-IIA 期宫颈癌的女性患者。任何癌组织学类型均被允许。临床风险分层根据 GOG 92 和 GOG 109 方案进行。采用卡方检验、t 检验、Kaplan-Meier 和 Cox 比例风险多变量统计分析疾病结局、复发模式和生存情况。
共确定 300 例患者，265 例符合纳入标准。中位随访时间为 56 个月。盆腔淋巴结切除术（PLND）在 71%的患者中进行，其余患者行联合腹主动脉旁解剖术（PPaLND）。两组患者的基线人口统计学和临床危险因素存在情况平衡良好。开放性手术中 PPaLND 更为常见（OR 10.58，p<.0001），且肿瘤在该组中更大（2.96cm 与 2.12cm，p=.0002）且更可能为非鳞状组织学类型（OR 2.02，p=.017）。疾病复发率为 13%，无论组织学类型如何，PLND 和 PPaLND 之间均无差异。两组均无孤立的 PaLN 复发。均未行预防性扩大野放疗（EFRT）。
在无可疑淋巴结的情况下，不进行 PaLN 解剖并未降低生存率。单独行 PLND 后无孤立的 PaLN 复发。
