Para-aortic and pelvic lymphadenectomy in locally advanced cervical cancer with pelvic lymph node metastasis.

IF 2.5 3区 医学 Q3 ONCOLOGY World Journal of Surgical Oncology Pub Date : 2024-09-30 DOI:10.1186/s12957-024-03540-0
Wei Jiang, Mei-Ling Zhong, Su-Lan Wang, Yan Chen, Ya-Nan Wang, Si-Yuan Zeng, Mei-Rong Liang
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Abstract

Objective: This study sought to explore the efficiency of para-aortic and pelvic lymphadenectomy in the treatment of locally advanced cervical cancer (LACC) with pelvic lymph node (PLN) metastasis.

Methods: A total of 171 LACC patients with imaging-confirmed pelvic lymph node metastasis were included in this study. These patients were divided into two groups: the surgical staging group, comprising 58 patients who had received para-aortic and pelvic lymphadenectomy (surgical staging) along with concurrent chemoradiation therapy (CCRT), and the imaging staging group, comprising 113 patients who had received only CCRT. The two groups' progression-free survival (PFS), overall survival (OS) and treatment-related complications were compared.

Results: The surgical staging group started radiotherapy 10.2 days (range 9-12 days) later than the imaging staging group. The overall incidence of lymphatic cysts was 9.30%. In the surgical staging group, para-aortic lymph node metastasis was identified in 34.48% (20/58) of patients, while pathology-negative PLN was observed in 12.07% (7/58). Over a median follow-up period of 52 months, no significant differences in PFS and OS rates were found between the two groups (p > 0.05). Subgroup analysis of patients with lymph node diameters of ≥ 1.5 cm revealed a five-year PFS rate of 75.0% and an OS rate of 80.0% in the surgical staging group, compared to 41.5% and 50.1% in the imaging staging group, respectively, showing statistically significant differences (p = 0.022, HR:0.34 [0.13, 0.90] and p = 0.038, HR: 0.34 [0.12,0.94], respectively for PFS and OS). Additionally, in patients with two or more metastatic lymph nodes, the five-year PFS and OS rates were 69.2% and 73.1% in the surgical staging group, versus 41.0% and 48.4% in the imaging staging group, with these differences also being statistically significant (p = 0.025, HR: 0.41[0.19,0.93] and p = 0.046, HR: 0.42[0.18,0.98], respectively).

Conclusion: Performing surgical staging before CCRT is safe and delivers accurate lymph node details crucial for tailoring radiotherapy. This approach merits further investigation, particularly in women with pelvic lymph nodes measuring 1.5 cm or more in diameter or patients with two or more imaging-positive PLNs.

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局部晚期宫颈癌伴盆腔淋巴结转移的主动脉旁和盆腔淋巴结切除术。
研究目的本研究旨在探讨主动脉旁和盆腔淋巴结切除术在治疗伴有盆腔淋巴结转移的局部晚期宫颈癌(LACC)中的有效性:本研究共纳入了171例经影像学证实有盆腔淋巴结转移的局部晚期宫颈癌患者。这些患者被分为两组:手术分期组和影像学分期组,手术分期组中有58名患者接受了主动脉旁和盆腔淋巴结切除术(手术分期),并同时接受了化疗(CCRT);影像学分期组中有113名患者仅接受了CCRT。比较了两组患者的无进展生存期(PFS)、总生存期(OS)和治疗相关并发症:结果:手术分期组比影像分期组晚10.2天(9-12天)开始放疗。淋巴囊肿的总发生率为9.30%。在手术分期组中,34.48%的患者(20/58)发现主动脉旁淋巴结转移,12.07%的患者(7/58)观察到病理阴性淋巴结。中位随访期为 52 个月,两组患者的 PFS 和 OS 率无明显差异(P > 0.05)。对淋巴结直径≥1.5厘米的患者进行的亚组分析显示,手术分期组的五年PFS率为75.0%,OS率为80.0%,而影像学分期组的PFS率和OS率分别为41.5%和50.1%,差异有统计学意义(P = 0.022,PFS和OS的HR:0.34 [0.13, 0.90]和P = 0.038,HR:0.34 [0.12,0.94])。此外,在有两个或两个以上转移淋巴结的患者中,手术分期组的五年生存期和OS率分别为69.2%和73.1%,而影像学分期组分别为41.0%和48.4%,这些差异也具有统计学意义(P = 0.025,HR:0.41[0.19,0.93]和P = 0.046,HR:0.42[0.18,0.98]):结论:在 CCRT 治疗前进行手术分期是安全的,并能提供准确的淋巴结详情,这对定制放疗至关重要。这种方法值得进一步研究,尤其是对于盆腔淋巴结直径大于或等于 1.5 厘米或有两个或两个以上影像学阳性淋巴结的女性患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.70
自引率
15.60%
发文量
362
审稿时长
3 months
期刊介绍: World Journal of Surgical Oncology publishes articles related to surgical oncology and its allied subjects, such as epidemiology, cancer research, biomarkers, prevention, pathology, radiology, cancer treatment, clinical trials, multimodality treatment and molecular biology. Emphasis is placed on original research articles. The journal also publishes significant clinical case reports, as well as balanced and timely reviews on selected topics. Oncology is a multidisciplinary super-speciality of which surgical oncology forms an integral component, especially with solid tumors. Surgical oncologists around the world are involved in research extending from detecting the mechanisms underlying the causation of cancer, to its treatment and prevention. The role of a surgical oncologist extends across the whole continuum of care. With continued developments in diagnosis and treatment, the role of a surgical oncologist is ever-changing. Hence, World Journal of Surgical Oncology aims to keep readers abreast with latest developments that will ultimately influence the work of surgical oncologists.
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