Comparison of pelvic and para-aortic lymphadenectomy versus para-aortic lymphadenectomy alone for locally advanced FIGO stage IB2 to IIB cervical cancer using a propensity score matching analysis: Results from the FRANCOGYN study group

Sofiane Bendifallah; Tiphaine de Foucher; Lobna Ouldamer; Alexandre Bricou; Vincent Lavoue; Justine Varinot; Geoffroy Canlorbe; Xavier Carcopino; Emilie Raimond; Florence Huguet; Olivier Graesslin; Cyril Touboul; Pierre Collinet; Cyrille Huchon; Emile Daraï; Marcos Ballester; Groupe de Recherche FRANCOGYN

doi:10.1016/j.ejso.2018.08.013

Comparison of pelvic and para-aortic lymphadenectomy versus para-aortic lymphadenectomy alone for locally advanced FIGO stage IB2 to IIB cervical cancer using a propensity score matching analysis: Results from the FRANCOGYN study group

Eur J Surg Oncol. 2018 Dec;44(12):1921-1928. doi: 10.1016/j.ejso.2018.08.013. Epub 2018 Aug 30.

Authors

Sofiane Bendifallah¹, Tiphaine de Foucher², Lobna Ouldamer³, Alexandre Bricou⁴, Vincent Lavoue⁵, Justine Varinot⁶, Geoffroy Canlorbe², Xavier Carcopino⁷, Emilie Raimond⁸, Florence Huguet⁹, Olivier Graesslin⁸, Cyril Touboul¹⁰, Pierre Collinet¹¹, Cyrille Huchon¹², Emile Daraï¹³, Marcos Ballester¹³; Groupe de Recherche FRANCOGYN

Affiliations

¹ Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), France; INSERM UMR_S_938, University Pierre et Marie Curie, Paris 6, France. Electronic address: [email protected].
² Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), France.
³ Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, Tours, France.
⁴ Department of Obstetrics, Gynecology and Reproductive Medicine, Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique-Hôpitaux de Paris, France.
⁵ CRLCC Eugène-Marquis, service de gynécologie, CHU de Rennes, université de Rennes 1, France.
⁶ Department of Pathology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France.
⁷ Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), CNRS, IRD, Marseille, France.
⁸ Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France.
⁹ Department of Radiation, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France.
¹⁰ Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France.
¹¹ Department of Gynecologic Surgery, Jeanne de Flandre Hospital, CHU de Lille, Lille, France.
¹² Department of Obstetrics and Gynecology, Poissy-St Germain Hospital, Poissy, France.
¹³ Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), France; INSERM UMR_S_938, University Pierre et Marie Curie, Paris 6, France.

PMID: 30213717
DOI: 10.1016/j.ejso.2018.08.013

Abstract

Introduction: Pre-treatment evaluation of nodal status is crucial in women presenting with locally advanced cervical cancer (LACC). However, the prognostic impact of surgical staging remains to be proved, as published results comparing surgical versus radiological staging are contradictory. The aim of this study was to compare the prognosis of women with FIGO stage IB2-IIB CC who underwent surgical nodal staging including either exclusive para-aortic lymphadenectomy (PAL) or comprehensive pelvic + para-aortic lymphadenectomy (P-PAL).

Materials and methods: Data of 314 women with FIGO stage IB2 to IIB CC treated between January 2000 and January 2015 were retrospectively abstracted from nine French institutions. The prognosis and outcomes were compared by Propensity score (PS) matching (PSM) analysis.

Results: The median follow-up was 33 months (2-114). When comparing women who underwent PAL vs P-PAL, the recurrence rates were 26% (37/144) and 28% (41/144), respectively (p = 0.595). The respective 3-year recurrence free survival (RFS) for P-PAL and PAL were 72.9% (95% CI, 65.7-81.0) and 70.7% (95% CI, 62.4-80.2), (p = 0.394). The respective 3-year overall survival (OS) rates for P-PAL and PAL were 86.8% (95% CI, 81.1-92.9) and 78.6% (95% CI, 70.4-87.7) (p = 0.592). In the sub-group of women with lymph node metastases, RFS was improved for women who underwent P-PAL compared to those with exclusive PAL (p = 0.027), with no difference in OS (p = 0.187).

Conclusions: Comprehensive P-PAL does not seem to be of significant therapeutic benefit compared to exclusive PAL.

Keywords: Locally advanced cervical cancer; Lymphadenectomy; Survival.

Publication types

Comparative Study

MeSH terms

Adult
Aged
Aorta, Abdominal
Female
Humans
Lymph Node Excision / methods*
Lymphatic Metastasis / pathology*
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Pelvis
Prognosis
Propensity Score
Survival Rate
Uterine Cervical Neoplasms / pathology*
Uterine Cervical Neoplasms / therapy