Number of paraaortic lymph node dissections as a prognostic factor in locally advanced cervical cancer

Abstract

Background: Lymph node (LN) metastases are the most important prognostic factor in locally advanced cervical cancer. Paraaortic lymphadenectomy is the only method able to confirm the presence of metastasis and thereby help to determine the most adequate treatment approach. There is no standard regarding the minimal number of LNs that should be removed in paraaortic lymphadenectomy. Women with undiagnosed positive paraaortic LNs (false negatives) due to a low LN count do not receive extended-field radiation therapy, which may lead to worse survival outcomes. The aim of this study is to confirm LN metastases as poor prognosis and to assess whether in cases of locally advanced CC with negative paraaortic LN status, the number of paraaortic LN laparoscopically removed carries a prognostic value.

Methods: We analyzed 78 patients with locally advanced cervical cancer that underwent complete paraaortic lymphadenectomy.

Results: Fifteen (19.2%) women had paraaortic LN metastases. The mean number of LN extracted was 11.1 (SD 7.5). Patients with paraaortic LN metastases presented a worse overall survival (127.1 months [95% CI 111.7-142.4] vs. 59.6 months [95% CI 31.2-87.9]; p<0.01). Nevertheless, there were no differences regarding disease-free survival. There were no prognostic differences according to the number of LNs resected in patients with negative lymphadenectomy.

Conclusions: Patients with locally advanced cervical cancer and paraaortic LN metastases present worse survival. In women with negative paraaortic LN, the number of LNs removed does not imply shorter survival.

Keywords: Advanced cervical cancer; Cáncer de cuello de útero avanzado; Linfadenectomía paraaórtica; Paraaortic lymphadenectomy; Prognosis; Pronóstico.