Background: We aimed to determine whether surgical aortic staging by minimally invasive paraaortic lymphadenectomy (PALND) affects the pattern of first recurrence and survival in treated locally advanced cervical cancer (LACC) patients when compared to patients staged by imaging (noPALND). Methods: This study was a multicenter observational retrospective cohort study of patients with LACC treated at tertiary care hospitals throughout Spain. The inclusion criteria were histological diagnosis of squamous carcinoma, adenosquamous carcinoma, and/or adenocarcinoma; FIGO stages IB2, IIA2-IVA (FIGO 2009); and planned treatment with primary chemoradiotherapy between 2000 and 2016. Propensity score matching (PSM) was performed before the analysis. Results: After PSM and sample replacement, 1092 patients were included for analysis (noPALND n = 546, PALND n = 546). Twenty-one percent of patients recurred during follow-up, with the PALND group having almost double the recurrences of the noPALND group (noPALND: 15.0%, PALND: 28.0%,p< 0.001). Nodal (regional) recurrences were more frequently observed in PALND patients (noPALND:2.4%, PALND: 11.2%,p< 0.001). Among those who recurred regionally, 57.1% recurred at the pelvic nodes, 37.1% recurred at the aortic nodes, and 5.7% recurred simultaneously at both the pelvic and aortic nodes. Patients who underwent a staging PALND were more frequently diagnosed with a distant recurrence (noPALND: 7.0%, PALND: 15.6%,p< 0.001). PALND patients presented poorer overall, cancer-specific, and disease-free survival when compared to patients in the noPALND group. Conclusion: After treatment, surgically staged patients with LACC recurred more frequently and showed worse survival rates.
背景：本研究旨在比较接受微创主动脉旁淋巴结清扫术（PALND）进行手术分期与仅通过影像学检查（noPALND）进行分期的局部晚期宫颈癌（LACC）患者，探讨手术分期对首次复发模式及生存率的影响。方法：本研究为多中心观察性回顾性队列研究，纳入2000年至2016年间在西班牙多家三级医院接受治疗的LACC患者。纳入标准包括：经组织学确诊的鳞状细胞癌、腺鳞癌和/或腺癌；FIGO分期为IB2、IIA2至IVA期（依据2009年FIGO分期标准）；计划接受根治性放化疗作为初始治疗。数据分析前进行了倾向性评分匹配（PSM）。结果：经PSM及样本替换后，共纳入1092例患者进行分析（noPALND组546例，PALND组546例）。随访期间21%的患者出现复发，其中PALND组的复发率接近noPALND组的两倍（noPALND组：15.0%，PALND组：28.0%，p<0.001）。PALND组患者更常出现淋巴结（区域）复发（noPALND组：2.4%，PALND组：11.2%，p<0.001）。在区域复发病例中，57.1%发生于盆腔淋巴结，37.1%发生于主动脉旁淋巴结，5.7%同时发生于盆腔及主动脉旁淋巴结。接受PALND分期的患者更常被诊断为远处转移（noPALND组：7.0%，PALND组：15.6%，p<0.001）。与noPALND组相比，PALND组患者的总生存率、癌症特异性生存率和无病生存率均较差。结论：治疗后，接受手术分期的LACC患者复发率更高，生存率更低。
肿瘤(癌症)患者之家