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

Cibula, D. ; Dostalek, L. ; Hillemanns, P. ; Scambia, G. ; Jarkovsky, J. ; Persson, J. LU ; Raspagliesi, F. ; Novak, Z. ; Jaeger, A. and Capilna, M. E. , et al. (2021) In European Journal of Cancer 143. p.88-100
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... (More)

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.

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type
Contribution to journal
publication status
published
subject
keywords
Cervical cancer, Pelvic lymphadenectomy, Radical hysterectomy, Radical hysterectomy abandonment, Radical hysterectomy completion
in
European Journal of Cancer
volume
143
pages
13 pages
publisher
Elsevier
external identifiers
  • scopus:85097244416
  • pmid:33290995
ISSN
0959-8049
DOI
10.1016/j.ejca.2020.10.037
language
English
LU publication?
yes
id
3c38015e-c201-42d8-9e9f-cd9682ad1462
date added to LUP
2020-12-15 06:33:21
date last changed
2021-02-23 01:33:58
@article{3c38015e-c201-42d8-9e9f-cd9682ad1462,
  abstract     = {<p>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.</p>},
  author       = {Cibula, D. and Dostalek, L. and Hillemanns, P. and Scambia, G. and Jarkovsky, J. and Persson, J. and Raspagliesi, F. and Novak, Z. and Jaeger, A. and Capilna, M. E. and Weinberger, V. and Klat, J. and Schmidt, R. L. and Lopez, A. and Scibilia, G. and Pareja, R. and Kucukmetin, A. and Kreitner, L. and El-Balat, A. and Pereira, G. J.R. and Laufhütte, S. and Isla-Ortiz, D. and Toptas, T. and Gil-Ibanez, B. and Vergote, I. and Runnenbaum, I.},
  issn         = {0959-8049},
  language     = {eng},
  pages        = {88--100},
  publisher    = {Elsevier},
  series       = {European Journal of Cancer},
  title        = {Completion of radical hysterectomy does not improve survival of patients with cervical cancer and intraoperatively detected lymph node involvement : ABRAX international retrospective cohort study},
  url          = {http://dx.doi.org/10.1016/j.ejca.2020.10.037},
  doi          = {10.1016/j.ejca.2020.10.037},
  volume       = {143},
  year         = {2021},
}