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Radical hysterectomy with or without para-aortic lymphadenectomy for patients with stage IB2, IIA2, and IIB cervical cancer: outcomes for a series of 308 patients

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Abstract

Background

Although many studies have already shown that lymph node metastasis is one of the major prognostic factors for cervical cancer, the therapeutic significance of para-aortic lymphadenectomy for the surgical treatment of cervical cancer remains controversial.

Methods

A total of 308 patients diagnosed with stage IB2, IIA2, or IIB cervical cancer and treated with radical hysterectomy were retrospectively investigated to assess the incidence of para-aortic lymph node metastasis and the clinicopathological factors linked to cervical cancer prognosis.

Results

Para-aortic lymph node metastases were pathologically confirmed in 13 of the 136 patients (9.6 %) who underwent para-aortic lymphadenectomy. The incidence of para-aortic lymph node metastasis was significantly higher in the patients who had common iliac lymph node metastases (odds ratio 31.5, p < 0.001) according to logistic regression analysis. Common iliac lymph node metastasis was related to risk of recurrence (hazard ratio 2.43, p = 0.003) and death (hazard ratio 2.62, p = 0.007) in Cox regression analysis. Kaplan–Meier analysis and Cox regression analysis showed that para-aortic lymphadenectomy did not have a positive impact on survival in 308 patients or 140 pN1 patients, but para-aortic lymphadenectomy was related to better overall survival with a marginal trend toward significance (p = 0.053) in 30 patients with common iliac lymph node metastasis.

Conclusions

Indication for para-aortic lymphadenectomy in the surgical treatment of stage IB2, IIA2, or IIB cervical cancer needs to be individualized. Patients with common iliac lymph node metastasis are possible candidates, and a prospective study is needed to clarify this issue.

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Author notes

    Authors and Affiliations

    1. Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

      Tetsushi Tsuruga, Asaha Fujimoto, Kei Kawana, Mayuyo Mori, Kensuke Tomio, Michihiro Tanikawa, Kenbun Sone, Yuichiro Miyamoto, Yuji Ikeda, Satoko Kojima, Katsuyuki Adachi, Kazunori Nagasaka, Yoko Matsumoto, Takahide Arimoto, Katsutoshi Oda, Shunsuke Nakagawa, Yutaka Osuga & Tomoyuki Fujii

    2. Department of Gynecology, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita-adachi-Gun, Saitama, 362-0806, Japan

      Yoko Hasumi, Shiho Miura, Koji Horie & Harushige Yokota

    3. Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan

      Nao Kino & Toshiharu Yasugi

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    1. Tetsushi Tsuruga
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    Corresponding author

    Correspondence to Kei Kawana.

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    The authors declare that they have no conflict of interest.

    Additional information

    T. Tsuruga and A. Fujimoto contributed equally to this study as first authors.

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    Cite this article

    Tsuruga, T., Fujimoto, A., Kawana, K. et al. Radical hysterectomy with or without para-aortic lymphadenectomy for patients with stage IB2, IIA2, and IIB cervical cancer: outcomes for a series of 308 patients. Int J Clin Oncol 21, 359–366 (2016). https://doi.org/10.1007/s10147-015-0907-3

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    • DOI: https://doi.org/10.1007/s10147-015-0907-3

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