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

J 2021

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., L. DOSTALEK, P. HILLEMANNS, G. SCAMBIA, Jiří JARKOVSKÝ et. al.

Basic information

Original name

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

Authors

CIBULA, D. (203 Czech Republic), L. DOSTALEK (203 Czech Republic), P. HILLEMANNS, G. SCAMBIA, Jiří JARKOVSKÝ (203 Czech Republic, belonging to the institution), J. PERSSON, F. RASPAGLIESI, Z. NOVAK (203 Czech Republic), A. JAEGER, M. E. CAPILNA, Vít WEINBERGER (203 Czech Republic, belonging to the institution), J. KLAT, R. L. SCHMIDT, A. LOPEZ, G. SCIBILIA, R. PAREJA, A. KUCUKMETIN, L. KREITNER, A. EL-BALAT, G. J. R. PEREIRA, S. LAUFHUTTE, D. ISLA-ORTIZ, T. TOPTAS, B. GIL-IBANEZ, I. VERGOTE and I. RUNNENBAUM

Edition

European Journal of Cancer, Oxford, Elsevier Science Inc. 2021, 0959-8049

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30204 Oncology

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 10.002

RIV identification code

RIV/00216224:14110/21:00121366

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.ejca.2020.10.037

UT WoS

000604902700014

Keywords in English

Cervical cancer; Radical hysterectomy; Pelvic lymphadenectomy; Radical hysterectomy completion; Radical hysterectomy abandonment

Abstract

V originále

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. (C) 2020 Elsevier Ltd. All rights reserved.

Citovat

CIBULA, D., L. DOSTALEK, P. HILLEMANNS, G. SCAMBIA, Jiří JARKOVSKÝ, J. PERSSON, F. RASPAGLIESI, Z. NOVAK, A. JAEGER, M. E. CAPILNA, Vít WEINBERGER, J. KLAT, R. L. SCHMIDT, A. LOPEZ, G. SCIBILIA, R. PAREJA, A. KUCUKMETIN, L. KREITNER, A. EL-BALAT, G. J. R. PEREIRA, S. LAUFHUTTE, D. ISLA-ORTIZ, T. TOPTAS, B. GIL-IBANEZ, I. VERGOTE and I. RUNNENBAUM. Completion of radical hysterectomy does not improve survival of patients with cervical cancer and intraoperatively detected lymph node involvement: ABRAX international retrospective cohort study. European Journal of Cancer. Oxford: Elsevier Science Inc., 2021, vol. 143, JAN 2021, p. 88-100. ISSN 0959-8049. Available from: https://dx.doi.org/10.1016/j.ejca.2020.10.037.

@article{1758078,
   author = {Cibula, D. and Dostalek, L. and Hillemanns, P. and Scambia, G. and Jarkovský, Jiří and Persson, J. and Raspagliesi, F. and Novak, Z. and Jaeger, A. and Capilna, M. E. and Weinberger, Vít and Klat, J. and Schmidt, R. L. and Lopez, A. and Scibilia, G. and Pareja, R. and Kucukmetin, A. and Kreitner, L. and ElandBalat, A. and Pereira, G. J. R. and Laufhutte, S. and IslaandOrtiz, D. and Toptas, T. and GilandIbanez, B. and Vergote, I. and Runnenbaum, I.},
   article_location = {Oxford},
   article_number = {JAN 2021},
   doi = {http://dx.doi.org/10.1016/j.ejca.2020.10.037},
   keywords = {Cervical cancer; Radical hysterectomy; Pelvic lymphadenectomy; Radical hysterectomy completion; Radical hysterectomy abandonment},
   language = {eng},
   issn = {0959-8049},
   journal = {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 = {https://www.sciencedirect.com/science/article/pii/S0959804920313265?via%3Dihub},
   volume = {143},
   year = {2021}
}

TY  - JOUR
ID  - 1758078
AU  - Cibula, D. - Dostalek, L. - Hillemanns, P. - Scambia, G. - Jarkovský, Jiří - Persson, J. - Raspagliesi, F. - Novak, Z. - Jaeger, A. - Capilna, M. E. - Weinberger, Vít - Klat, J. - Schmidt, R. L. - Lopez, A. - Scibilia, G. - Pareja, R. - Kucukmetin, A. - Kreitner, L. - El-Balat, A. - Pereira, G. J. R. - Laufhutte, S. - Isla-Ortiz, D. - Toptas, T. - Gil-Ibanez, B. - Vergote, I. - Runnenbaum, I.
PY  - 2021
TI  - Completion of radical hysterectomy does not improve survival of patients with cervical cancer and intraoperatively detected lymph node involvement: ABRAX international retrospective cohort study
JF  - European Journal of Cancer
VL  - 143
IS  - JAN 2021
SP  - 88-100
EP  - 88-100
PB  - Elsevier Science Inc.
SN  - 09598049
KW  - Cervical cancer
KW  - Radical hysterectomy
KW  - Pelvic lymphadenectomy
KW  - Radical hysterectomy completion
KW  - Radical hysterectomy abandonment
UR  - https://www.sciencedirect.com/science/article/pii/S0959804920313265?via%3Dihub
N2  - 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. (C) 2020 Elsevier Ltd. All rights reserved.
ER  -

CIBULA, D., L. DOSTALEK, P. HILLEMANNS, G. SCAMBIA, Jiří JARKOVSKÝ, J. PERSSON, F. RASPAGLIESI, Z. NOVAK, A. JAEGER, M. E. CAPILNA, Vít WEINBERGER, J. KLAT, R. L. SCHMIDT, A. LOPEZ, G. SCIBILIA, R. PAREJA, A. KUCUKMETIN, L. KREITNER, A. EL-BALAT, G. J. R. PEREIRA, S. LAUFHUTTE, D. ISLA-ORTIZ, T. TOPTAS, B. GIL-IBANEZ, I. VERGOTE and I. RUNNENBAUM. Completion of radical hysterectomy does not improve survival of patients with cervical cancer and intraoperatively detected lymph node involvement: ABRAX international retrospective cohort study. \textit{European Journal of Cancer}. Oxford: Elsevier Science Inc., 2021, vol.~143, JAN 2021, p.~88-100. ISSN~0959-8049. Available from: https://dx.doi.org/10.1016/j.ejca.2020.10.037.

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