Background: Guidelines recommend the extension of the pelvic radiotherapy volume to the para-aortic region in locally advanced cervical cancer and ≥3 suspicious pelvic lymph nodes (PLN) on imaging. Whether this recommendation is also valid for clinically early stages is uncertain. The objective of this study was to investigate the para-aortic (PAO) lymph node recurrence rate in patients with early-stage cervical cancer, ≥3 metastatic PLN, and negative common iliac nodes after a radical hysterectomy followed by pelvic (chemo)radiotherapy without extension to the PAO region. Methods: Consecutive patients, surgically treated between 2000 and 2020, with FIGO 2009 stage IB2-IIA1 and positive PLN, were included in this retrospective cohort study. The frequency of PAO recurrences, disease-free survival, and overall survival were analyzed in patients with <3 versus ≥3 positive PLN. Results: In 127 patients, the isolated PAO recurrence rate was 2/88 (2.3%) versus 1/39 (2.6%) for patients with <3 versus ≥3 positive PLNs, respectively (p= 0.671). The 5-year disease-free survival (87.3% versus 73.7%;p= 0.088) and the overall survival (90.7% versus 76.5%;p= 0.355) between patients with <3 versus ≥3 positive PLN was not significantly different. Conclusions: Isolated PAO nodal recurrence rate in women with early-stage cervical cancer after radical hysterectomy and pelvic lymphadenectomy, with positive PLN but negative common iliac nodes, followed by pelvic (chemo)radiotherapy, is low and did not differ between the groups with <3 versus ≥3 positive PLN. This makes it unlikely that the inclusion of the PAO region in the adjuvant radiotherapy volume would result in a better oncological outcome.
背景：对于局部晚期宫颈癌且影像学检查提示≥3个可疑盆腔淋巴结的患者，指南建议将盆腔放疗范围扩展至腹主动脉旁区域。然而，该建议是否同样适用于临床早期阶段尚不明确。本研究旨在探讨早期宫颈癌患者，在根治性子宫切除术后接受盆腔（化疗）放疗（未扩展至腹主动脉旁区域）后，若存在≥3个转移性盆腔淋巴结但髂总淋巴结阴性，其腹主动脉旁淋巴结复发率。 方法：本回顾性队列研究纳入了2000年至2020年间连续接受手术治疗、根据FIGO 2009分期为IB2-IIA1期且盆腔淋巴结阳性的患者。分析比较了盆腔阳性淋巴结<3个与≥3个患者的腹主动脉旁复发率、无病生存期和总生存期。 结果：在127例患者中，盆腔阳性淋巴结<3个与≥3个患者的孤立性腹主动脉旁复发率分别为2/88（2.3%）和1/39（2.6%）（p=0.671）。两组患者的5年无病生存率（87.3%对73.7%；p=0.088）和总生存率（90.7%对76.5%；p=0.355）无显著差异。 结论：对于早期宫颈癌患者，在接受根治性子宫切除术和盆腔淋巴结清扫术后，若盆腔淋巴结阳性但髂总淋巴结阴性，并随后接受盆腔（化疗）放疗，其孤立性腹主动脉旁淋巴结复发率较低，且盆腔阳性淋巴结<3个与≥3个的患者之间无差异。这表明，在辅助放疗范围中纳入腹主动脉旁区域不太可能带来更好的肿瘤学结局。
肿瘤(癌症)患者之家