Completion of radical hysterectomy does not improve survival of patients with cervical cancer and intraoperatively detected lymph node involvement: ABRAX international retrospective cohort study

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Abstract

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.

Details

Authors
  • D. Cibula
  • L. Dostalek
  • P. Hillemanns
  • G. Scambia
  • J. Jarkovsky
  • F. Raspagliesi
  • Z. Novak
  • A. Jaeger
  • M. E. Capilna
  • V. Weinberger
  • J. Klat
  • R. L. Schmidt
  • A. Lopez
  • G. Scibilia
  • R. Pareja
  • A. Kucukmetin
  • L. Kreitner
  • A. El-Balat
  • G. J.R. Pereira
  • S. Laufhütte
  • D. Isla-Ortiz
  • T. Toptas
  • B. Gil-Ibanez
  • I. Vergote
  • I. Runnenbaum
Organisations
External organisations
  • General University Hospital in Prague
  • Hannover Medical School
  • Policlinico Universitario Agostino Gemelli
  • Masaryk University
  • Istituto Nazionale dei Tumori
  • National Institute of Oncology, Budapest
  • University Medical Center Hamburg-Eppendorf
  • University of Medicine and Pharmacy of Târgu Mureș
  • University Hospital Ostrava
  • Instituto Nacional de Enfermedades Neoplasicas
  • Queen Elizabeth Hospital, Gateshead
  • University Hospital Frankfurt
  • University Hospitals Leuven
  • Universitätsklinikum Jena
  • Skåne University Hospital
  • Charles University in Prague
  • Barretos Cancer Hospital
  • Cannizzaro Hospital
  • Pontificia Bolivariana University
  • St. Franziskus-Hospital, Münster
  • Goethe University
  • Clinica Las Americas, Medellin
  • Kreiskliniken Altötting-Burghausen
  • National Cancer Institute, Mexico
  • Antalya Training and Research Hospital.
  • Hospital Clínic of Barcelona
  • Friedrich Schiller University Jena
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology

Keywords

  • Cervical cancer, Pelvic lymphadenectomy, Radical hysterectomy, Radical hysterectomy abandonment, Radical hysterectomy completion
Original languageEnglish
Pages (from-to)88-100
Number of pages13
JournalEuropean Journal of Cancer
Volume143
Publication statusPublished - 2021
Publication categoryResearch
Peer-reviewedYes