Comparison of survival outcomes with or without Para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer in China from 2004 to 2016
Chunlin Chen,
Hui Duan,
Wenling Zhang,
Hongwei Zhao,
Li Wang,
Shan Kang,
Lihong Lin,
Weidong Zhao,
Yan Ni,
Donglin Li,
Jiaming Chen,
Huijian Fan,
Xiaolin Chen,
Xiaonong Bin,
Jinghe Lang,
Ping Liu
Affiliations
Chunlin Chen
Department of Obstetrics and Gynaecology, Nanfang Hospital, Southern Medical University
Hui Duan
Department of Obstetrics and Gynaecology, Nanfang Hospital, Southern Medical University
Wenling Zhang
Department of Obstetrics and Gynaecology, Nanfang Hospital, Southern Medical University
Hongwei Zhao
Department of Gynaecologic Oncology, Shanxi Provincial Cancer Hospital
Li Wang
Department of Gynaecologic Oncology, Affiliated Tumour Hospital of Zhengzhou University
Shan Kang
Department of Gynaecology, Fourth Hospital Hebei Medical University
Lihong Lin
Department of Obstetrics and Gynaecology, The Anyang Tumor Hospital of Henan Province
Weidong Zhao
Department of Gynaecology, Anhui Cancer Hospital
Yan Ni
Department of Obstetrics and Gynaecology, Yuncheng Central Hospital
Donglin Li
Department of Obstetrics and Gynaecology, Guizhou People’s Hospital
Jiaming Chen
Department of Obstetrics and Gynaecology, Nanfang Hospital, Southern Medical University
Huijian Fan
Department of Obstetrics and Gynaecology, Nanfang Hospital, Southern Medical University
Xiaolin Chen
Department of Obstetrics and Gynaecology, Nanfang Hospital, Southern Medical University
Xiaonong Bin
Department of Epidemiology, College of Public Health, Guangzhou Medical University
Jinghe Lang
Department of Obstetrics and Gynaecology, Nanfang Hospital, Southern Medical University
Ping Liu
Department of Obstetrics and Gynaecology, Nanfang Hospital, Southern Medical University
Abstract Background Current opinions on whether surgical patients with cervical cancer should undergo para-aortic lymphadenectomy at the same time are inconsistent. The present study examined differences in survival outcomes with or without para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer. Methods We retrospectively compared the survival outcomes of 8802 stage IB1-IIA2 cervical cancer patients (FIGO 2009) who underwent abdominal radical hysterectomy + pelvic lymphadenectomy (n = 8445) or abdominal radical hysterectomy + pelvic lymphadenectomy + para-aortic lymphadenectomy (n = 357) from 37 hospitals in mainland China. Results Among the 8802 patients with stage IB1-IIA2 cervical cancer, 1618 (18.38%) patients had postoperative pelvic lymph node metastases, and 37 (10.36%) patients had para-aortic lymph node metastasis. When pelvic lymph nodes had metastases, the para-aortic lymph node simultaneous metastasis rate was 30.00% (36/120). The risk of isolated para-aortic lymph node metastasis was 0.42% (1/237). There were no significant differences in the survival outcomes between the para-aortic lymph node unresected and resected groups. No differences in the survival outcomes were found before or after matching between the two groups regardless of pelvic lymph node negativity/positivity. Conclusion Para-aortic lymphadenectomy did not improve 5-year survival outcomes in surgical patients with stage IB1-IIA2 cervical cancer. Therefore, when pelvic lymph node metastasis is negative, the risk of isolated para-aortic lymph node metastasis is very low, and para-aortic lymphadenectomy is not recommended. When pelvic lymph node metastasis is positive, para-aortic lymphadenectomy should be carefully selected because of the high risk of this procedure.
