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Completion of radical hysterectomy does not improve survival of patients with cervical cancer and intraoperatively detected lymph node involvement: ABRAX international retrospective cohort study
D. Cibula, L. Dostalek, P. Hillemanns, G. Scambia, J. Jarkovsky, J. Persson, F. Raspagliesi, Z. Novak, A. Jaeger, ME. Capilna, V. Weinberger, J. Klat, RL. Schmidt, A. Lopez, G. Scibilia, R. Pareja, A. Kucukmetin, L. Kreitner, A. El-Balat, GJR....
Language English Country Great Britain
Document type Journal Article, Research Support, Non-U.S. Gov't
- MeSH
- Survival Analysis MeSH
- Adult MeSH
- Hysterectomy methods MeSH
- Cohort Studies MeSH
- Middle Aged MeSH
- Humans MeSH
- Uterine Cervical Neoplasms mortality pathology surgery MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
BACKGROUND: The management of cervical cancer patients with intraoperative detection of lymph node involvement remains controversial. Since all these patients are referred for (chemo)radiation after the surgery, the key decision is whether radical hysterectomy should be completed as originally planned, taking into account an additional morbidity associated with extensive surgical dissection prior to adjuvant treatment. The ABRAX study investigated whether completing a radical uterine procedure is associated with an improved oncological outcome of such patients. PATIENTS AND METHODS: We performed retrospective analyses of 515 cervical cancer patients (51 institutions, 19 countries) who were referred for primary curative surgery between 2005 and 2015 (stage IA-IIB, common tumour types) in whom lymph node involvement was detected intraoperatively. Patients were stratified according to whether the planned uterine surgery was completed (COMPL group, N = 361) or abandoned (ABAND group, N = 154) to compare progression-free survival. Definitive chemoradiation was given to 92.9% patients in the ABAND group and adjuvant (chemo)radiation or chemotherapy to 91.4% of patients in the COMPL group. RESULTS: The risks of recurrence (hazard ratio [HR] 1.154, 95% confidence intervals [CI] 0.799-1.666, P = 0.45), pelvic recurrence (HR 0.836, 95% CI 0.458-1.523, P = 0.56), or death (HR 1.064, 95% CI 0.690-1.641, P = 0.78) were not significantly different between the two groups. No subgroup showed a survival benefit from completing radical hysterectomy. Disease-free survival reached 74% (381/515), with a median follow-up of 58 months. Prognostic factors were balanced between the two groups. FIGO stage and number of pelvic lymph nodes involved were significant prognostic factors in the whole study cohort. CONCLUSION: We showed that the completion of radical hysterectomy does not improve survival in patients with intraoperatively detected lymph node involvement, regardless of tumour size or histological type. If lymph node involvement is confirmed intraoperatively, abandoning uterine radical procedure should be considered, and the patient should be referred for definitive chemoradiation. CLINICAL TRIALS IDENTIFIER: NCT04037124.
Cannizzaro Hospital Catania Italy
Comprehensive Oncology Gynecology Operational Unit Fondazione Policlinico Gemelli IRCCS Rome Italy
Department of Gynaecology and Obstetrics Medical University Hannover Hannover Germany
Department of Gynecological Surgery National Institute of Neoplastic Diseases Lima Peru
Department of Gynecology and Obstetrics Faculty of Medicine Masaryk University Brno Czech Republic
Department of Gynecology National Institute of Oncology Budapest Hungary
Department of Obstetrics and Gynecology District Hospital Altotting Altotting Germany
Department of Obstetrics and Gynecology University Hospital Ostrava Ostrava Poruba Czech Republic
Fondazione IRCCS Instituto Nazionale Tumori Milan Italy
Gynecologic Oncology Department Barretos Cancer Hospital Barretos Brazil
Gynecology Cancer Center St Franzis Hospital Munster Munster Germany
Gynecology Oncology Center National Institute of Cancerology Mexico Mexico
Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic
Northern Gynaecological Oncology Centre Queen Elizabeth Hospital Gateshead United Kingdom
University Clinic Frankfurt Goethe University Frankfurt Germany
References provided by Crossref.org
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