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Inicio Medicina Clínica (English Edition) Number of paraaortic lymph node dissections as a prognostic factor in locally ad...
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Vol. 155. Issue 5.
Pages 197-201 (September 2020)
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Vol. 155. Issue 5.
Pages 197-201 (September 2020)
Original article
Number of paraaortic lymph node dissections as a prognostic factor in locally advanced cervical cancer
Número de ganglios extraídos en la linfadenectomía paraaórtica como factor pronóstico en el cáncer de cérvix localmente avanzado
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Inmaculada Nicolása,
Corresponding author
inicolas@clinic.cat

Corresponding author.
, Juan Gilabert-Estellésb,c, Juan Gilabert-Aguilarb, Pere Fustéa, Kristina Aghababyanc, Jaume Pahisaa, Blanca Gil-Ibañeza, Berta Díaz-Feijooa, Francisco Carmonaa, Francisco Javier Calped, Adela Sacoe, Jaume Ordie, Aureli Tornea
a Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic – Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
b European Gynecology Endoscopy School (E.G.E.S.-Valencia), Valencia, Spain
c Endoscopy and Gynecologic Oncology Unit, Hospital General Universitario de Valencia, Valencia, Spain
d Institut Català de la Salut, Barcelona, Spain
e Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Tables (5)
Table 1. Clinical and histological characteristics of the patients with locally advanced CC by paraaortic LN status.
Table 2. Clinical and histological characteristics of the patients with locally advanced CC without paraaortic LN metastases.
Table 3. Overall survival and disease free survival of patients with locally advanced CC according to number of LN removed.
Table 4. Overall survival and disease free survival of patients with locally advanced CC with negative paraaortic LN metastases according to number of LN removed.
Table 5. Univariate Cox models.
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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:
Paraaortic lymphadenectomy
Prognosis
Advanced cervical cancer
Resumen
Antecedentes

Las metástasis linfáticas son el factor pronóstico más importante en el cáncer de cérvix localmente avanzado. La linfadenectomía paraaórtica es el único método capaz de confirmar la presencia de metástasis y, por lo tanto, ayudar a determinar el enfoque de tratamiento más adecuado. No existe una norma con respecto al número mínimo de ganglios que deben resecarse en la linfadenectomía paraaórtica. Las mujeres con ganglios paraaórticos positivos no diagnosticados (falsos negativos) debido a un bajo recuento no reciben radioterapia de campo extendido, lo que puede conducir a peores resultados de supervivencia. El objetivo de este estudio es confirmar las metástasis ganglionares como principal factor pronóstico y evaluar si, en los casos de cáncer de cérvix localmente avanzado sin metástasis ganglionares paraaórticas, el número de ganglios extraídos por laparoscopia tiene un valor pronóstico.

Métodos

Se analizaron 78 pacientes con cáncer cervical localmente avanzado que se sometieron a una linfadenectomía paraaórtica completa.

Resultados

Quince (19,2%) mujeres tuvieron metástasis ganglionares paraaórticas. El número medio de ganglios extraído fue de 11,1 (DE 7,5). Las pacientes con metástasis paraaórticas presentaron una peor supervivencia global (127,1 meses [IC del 95%: 111,7-142,4] frente a 59,6 meses [IC del 95%: 31,2 a 87,9]; p<0,01). Sin embargo, no hubo diferencias en cuanto a la supervivencia libre de enfermedad. No hubo diferencias pronósticas según el número de ganglios resecados en pacientes con linfadenectomía negativa.

Conclusiones

Las pacientes con cáncer cervical localmente avanzado y metástasis paraaórticas presentan peor supervivencia. En las mujeres con linfadenectomía paraaórtica negativa, el número de ganglios extraídos no implica una supervivencia peor.

Palabras clave:
Linfadenectomía paraaórtica
Pronóstico
Cáncer de cuello de útero avanzado

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