Golia D'Augè Tullio, Caruso Giuseppe, Laudani Maria Elena, Nazzaro Ludovica, De Vitis Luigi Antonio, Rosanu Nelia Marina, Ribero Lucia, Alessi Sarah, Lazzari Roberta, Betella Ilaria, Aletti Giovanni, Zanagnolo Vanna, Colombo Nicoletta, Schivardi Gabriella, Multinu Francesco
Department of Gynecologic Oncology, European Institute of Oncology, IEO, IRCCS, Milan, Italy.
Department of Experimental Medicine, University of Rome La Sapienza, Rome, Italy.
Int J Gynecol Cancer. 2024 Dec 2;34(12):1867-1873. doi: 10.1136/ijgc-2024-005950.
The standard treatment for early-stage cervical cancer includes radical hysterectomy with pelvic lymph node staging ± bilateral salpingo-oophorectomy. Para-aortic lymphadenectomy may be considered; however, its role remains controversial. The objective of this study was to assess the para-aortic lymph node recurrence rate in patients undergoing surgery for apparent early-stage cervical cancer without para-aortic lymph node surgical staging.
This is a retrospective cohort study including all consecutive patients with presumed early-stage (International Federation of Gynecology and Obstetrics (FIGO) 2018 IA1-IB2, IIA1) cervical cancer who underwent radical surgery at the European Institute of Oncology, Milan, Italy. Pelvic lymph node assessment included sentinel lymph node biopsy and/or systematic pelvic lymphadenectomy. Patients who underwent para-aortic lymphadenectomy or had an indication to receive adjuvant para-aortic radiotherapy were excluded. The Kaplan-Meier method was used to estimate 5-year recurrence-free survival.
Overall, 432 patients were included. The median age was 43.7 years (IQR 38.1-51.6). Sixteen (3.7%) patients were staged IA1 at diagnosis, 24 (5.6%) IA2, 208 (48.1%) IB1, 177 (41%) IB2, and 7 (1.6%) IIA1. At final pathology, the stage distribution was as follows: 36 (8.3%) stage IA1-IA2, 323 (74.8%) stage IB1-IB3, 17 (3.9%) stage II, and 56 (13%) stage IIIC1. Eighty-two patients (19%) underwent concurrent pelvic chemoradiotherapy, 20 (4.6%) radiotherapy alone, and 3 (0.7%) chemotherapy alone. Thirty-eight (8.8%) patients experienced a recurrence with a median time of 18 months (IQR 12-29). The median follow-up time for the remaining 394 (91.2%) patients was 70 months (IQR 36-98). Two patients (0.5%) had a recurrence in the para-aortic lymph nodes. The 5-year recurrence-free survival in the overall cohort was 90% (95% CI 87.4% to 93.3%).
Given the low rate of para-aortic lymph node recurrence in surgically treated early-stage cervical cancer and the well-established peri-operative complications associated with para-aortic lymphadenectomy, our study aligns with recent evidence supporting the omission of this procedure in such patients.
早期宫颈癌的标准治疗包括根治性子宫切除术及盆腔淋巴结分期±双侧输卵管卵巢切除术。可考虑行腹主动脉旁淋巴结清扫术；然而，其作用仍存在争议。本研究的目的是评估在未进行腹主动脉旁淋巴结手术分期的情况下，接受早期宫颈癌手术患者的腹主动脉旁淋巴结复发率。
这是一项回顾性队列研究，纳入了在意大利米兰欧洲肿瘤研究所接受根治性手术的所有连续的疑似早期（国际妇产科联盟（FIGO）2018年IA1-IB2、IIA1期）宫颈癌患者。盆腔淋巴结评估包括前哨淋巴结活检和/或系统性盆腔淋巴结清扫术。排除接受腹主动脉旁淋巴结清扫术或有指征接受辅助性腹主动脉旁放疗的患者。采用Kaplan-Meier法估计5年无复发生存率。
总共纳入了432例患者。中位年龄为43.7岁（四分位间距38.1-51.6）。16例（3.7%）患者诊断时为IA1期，24例（5.6%）为IA2期，208例（48.1%）为IB1期，177例（41%）为IB2期，7例（1.6%）为IIA1期。最终病理分期分布如下：IA1-IA2期36例（8.3%），IB1-IB3期323例（74.8%），II期17例（3.9%），IIIC1期56例（13%）。82例（19%）患者接受了同步盆腔放化疗，20例（4.6%）仅接受放疗，3例（0.7%）仅接受化疗。38例（8.8%）患者出现复发，中位复发时间为18个月（四分位间距12-29）。其余394例（91.2%）患者的中位随访时间为70个月（四分位间距36-98）。2例（0.5%）患者出现腹主动脉旁淋巴结复发。整个队列的5年无复发生存率为90%（95%CI 87.4%至93.3%）。
鉴于手术治疗的早期宫颈癌患者腹主动脉旁淋巴结复发率较低，且腹主动脉旁淋巴结清扫术存在已明确的围手术期并发症，我们的研究与最近支持在此类患者中省略该手术的证据一致。
