Laparoscopic para-aortic and pelvic lymphadenectomy before chemoradiotherapy was not associated with improved survival in patients with FIGO stage IIB-IIIC cervical cancer: a single-center retrospective study.

BACKGROUND

Currently, whether surgical staging can confer a survival benefit in patients with cervical cancer remains controversial, and its efficacy is similarly uncertain across different subgroups. The primary aim of this study was to assess the efficacy of laparoscopic para-aortic and pelvic lymphadenectomy prior to chemoradiotherapy in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIB-IIIC cervical cancer. The secondary aim was to identify the main prognostic factors.

METHODS

A total of 396 patients were included in this retrospective study, 97 patients who underwent laparoscopic para-aortic and pelvic lymphadenectomy before chemoradiotherapy comprised the surgical staging group, and 299 patients who received chemoradiotherapy alone comprised the clinical staging group. Kaplan-Meier and log-rank methods were used to construct and compare progression-free survival (PFS) and overall survival (OS) curves, respectively. Multivariable Cox proportional hazards regression models were used to identify independent prognostic factors.

RESULTS

There were no statistically significant differences in PFS (p = 0.187) or OS (p = 0.490) between the two groups. The estimated 5-year PFS rates were 67.0% (95%CI, 56.9%-75.7%) in the surgical staging group and 73.6% (95%CI, 67.4%-78.7%) in the clinical staging group. The corresponding 5-year OS rates were 76.3% (95%CI, 66.0%-83.9%) and 78.6% (95%CI, 72.7%-83.2%), respectively. Subgroup analysis stratified by imaging lymph node status demonstrated comparable survival outcomes. Multivariate analysis identified adenocarcinoma, pelvic wall involvement, and imaging-positive lymph nodes as independent risk factors for PFS; adenocarcinoma, adenosquamous carcinoma, pelvic wall involvement, and imaging-positive lymph nodes were independent predictors of OS.

CONCLUSIONS

Laparoscopic para-aortic and pelvic lymphadenectomy before chemoradiotherapy was not associated with improved PFS or OS in this retrospective cohort, Tumor histology, pelvic wall involvement, and imaging-positive lymph nodes were the main prognostic factors.