Para-Aortic Lymph Node Dissection for Patients with Node-Negative Cervical Squamous Cell Carcinoma: A Retrospective Cohort Study

Author:

Guo Qinhao12ORCID,Zhu Jun12ORCID,Wu Yong12ORCID,Wu Jiangchun12,Wang Simin12ORCID,Wen Hao12ORCID,Ju Xingzhu12ORCID,Wu Xiaohua12ORCID

Affiliation:

1. Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China

2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China

Abstract

Objective. The current guidelines for cervical cancer are uncertain regarding whether the para-aortic lymph nodes (PALNs) need to be removed. For patients with negative PALNs, whether the addition of PALN dissection (PALND) can be translated into survival benefits is unknown. Methods. The medical records of 3,995 patients with FIGO stage IB-IIA cervical squamous cell carcinoma (CSCC) who underwent abdominal radical surgery between 2006 and 2014 at our center were retrospectively reviewed. Two groups were identified: PALN-negative patients who underwent PALND (+PALND) and those who did not (−PALND). The groups were matched by propensity score matching (PSM). Survival was analyzed using the Kaplan–Meier method and the Cox proportional hazards model. Subgroups were stratified by the variables known at the time of diagnosis. Results. After PSM, 313 patients were matched to the −PALND (cohort 1) and +PALND (cohort 2) groups. Cohort 2 patients had a poorer prognosis than cohort 1 patients in terms of overall survival (OS, P = 0.014 ), and PALND was an independent prognostic factor for OS ( P = 0.021 ). There were no differences in recurrence patterns between the groups. Subgroup analysis showed that cohort 2 patients had worse OS than cohort 1 patients when they were aged ≤47 years ( P = 0.033 ), were premenopausal ( P = 0.032 ), were in stage IB ( P = 0.009 ), or had preoperative SCC-Ag<6.5 ( P = 0.009 ). Conclusions. PALND negatively impacts OS in early-stage PALN-negative CSCC patients. For CSCC patients who are clinically PALN-negative, especially those who are young, are premenopausal, have tumors confined to the cervix, and have relatively low SCC-Ag values, PALND may “rub salt on the wound.”

Funder

Shanghai Key Clinical Specialty Project

Publisher

Hindawi Limited

Subject

Oncology

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