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. 2021 Jan;32(1):e4.
doi: 10.3802/jgo.2021.32.e4. Epub 2020 Oct 26.

The extent of aortic lymphadenectomy in locally advanced cervical cancer impacts on survival

Antoni Llueca  1 , Javier Escrig  2 , Antonio Gil-Moreno  3 , Virginia Benito  4 , Alicia Hernández  5 , Berta Díaz-Feijoo  6 ; Spain-Gynecologic Oncology Group (GOG) Working Group
Affiliations

The extent of aortic lymphadenectomy in locally advanced cervical cancer impacts on survival

Antoni Llueca et al. J Gynecol Oncol. 2021 Jan.

Abstract

Objective: The 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 results of the surgical technique of preoperative aortic lymphadenectomy in LACC related to tumor burden and disease spread to assess its influence on survival.

Methods: Data of 1,072 patients with cervical cancer were taken from 11 Spanish hospitals (Spain-Gynecologic Oncology Group [GOG] working group). Complete aortic lymphadenectomy surgery (CALS) was considered when the lymph nodes (LNs) were excised up to the left renal vein. The extent of the disease was performed evaluating the LNs by calculating the geometric means and quantifying the log odds between positive LNs and negative LNs. 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.

Results: A total of 394 patients were included. Pathological analysis revealed positive aortic LNs in 119 patients (30%). LODDS cut-off value of -2 was established as a prognostic indicator. CALS and LODDS <-2 were associated with better disease free survival and overall survival than suboptimal aortic lymphadenectomy surgery and LODDS ≥-2. In a multivariate model analysis, CALS is revealed as an independent prognostic factor in LACC.

Conclusion: When performing preoperative surgical staging in LACC, it is not advisable to take simple samples from the regional nodes. Radical dissection of the aortic and pelvic regions offers a more reliable staging of the LNs and has a favorable influence on survival.

Keywords: Cervical Cancer; Disease-Free Survival; Lymph Node Excision; Lymphatic Metastasis; Survival Rate.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. CUSUM chart obtained for LODDS.
CUSUM, cumulative sum; LODDS, log odds of positive lymph nodes.
Fig. 2
Fig. 2. Medians OS for CALS and SALS (p log-rank=0.003).
CALS, complete aortic lymphadenectomy surgery; OS, overall survival; SALS, suboptimal aortic lymphadenectomy surgery.
See this image and copyright information in PMC

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