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Survival effect of laparoscopic para‐aortic staging in locally advanced cervical cancer: a retrospective cohort analysis
Author(s) -
Pomel C,
Martinez A,
Bourgin C,
Beguinot M,
Benoit C,
Naik R,
Dauplat J,
Lebouedec G,
Ferron G
Publication year - 2017
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.14492
Subject(s) - medicine , cervical cancer , hazard ratio , retrospective cohort study , lymphadenectomy , cohort , multivariate analysis , survival analysis , surgery , log rank test , cancer , confidence interval
Objective This study compares two methods of evaluating para‐aortic node involvement in locally advanced cervical cancer ( LACC ) in order to define external radiotherapy treatment fields: laparoscopic surgical para‐aortic lymphadenectomy or PET ‐ CT imaging. Population We selected 187 patients with LACC who had been treated by chemoradiation therapy in two comprehensive cancer centres from January 2001 to December 2013. A total of 98 underwent para‐aortic evaluation by PET ‐ CT (Centre 1) and 89 received surgical laparoscopic excision (Centre 2). Methods All patients with LACC were retrospectively collected in each centre. OS and DFS were calculated using the Kaplan–Meier's method and survival curves were compared using log‐rank test. Main outcome measures Outcomes were the comparison of patients’ disease‐free ( DFS ) and overall survival ( OS ) between the two centres. Results Patients had a significantly better disease‐free survival in cohort 1 than in cohort 2, at 2 years [80.9% (71.7–87.5) versus 57.1% (46.1–67.3)] and at 5 years [70.5% (58.8–79.9) versus 49.2% (38.2–60.4)] ( P = 0.009). These results are confirmed by multivariate analysis model [hazard ratio ( HR ) 1.93; 95% CI 1.03–3.61; P = 0.04]. The overall survival was also better in cohort 1, both at 2 and 5 years [93.5% (86.5–97.0) versus 78.5% (68.5–86.0) and 85.1% (73.2–92.2) versus 63.8% (51.9–74.2), respectively; P = 0.006]. The multivariate analysis model found concordant results with an increased relative risk of death for patients treated in cohort 2 ( HR 2.55; 95% CI 1.09–5.99; P = 0.01). Conclusion In this retrospective cohort analysis, para‐aortic surgical staging in LACC is more deleterious for patients than is radiological staging in terms of OS and DFS . Tweetable abstract Para‐aortic surgical staging in LACC is more deleterious for patients than clinical staging.