Could the Extent of Lymphadenectomy Be Modified by Neoadjuvant Chemotherapy in Cervical Cancer? A Large-scale Retrospective Study

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2015 Apr 11

PMID 25859857

Citations 1

Authors

Ting Hu

Xiong Li

Qinghua Zhang

Kecheng Huang

Yao Jia

Ru Yang

Fangxu Tang

Qiang Tian

Ding Ma

Shuang Li

Affiliations

Soon will be listed here.

Abstract

Background: The effect of neoadjuvant chemotherapy (NACT) on topographical distribution patterns of lymph node metastasis in cervical cancer was unknown.

Methods: Patients with FIGO stage IB1-IIB who underwent radical surgery with or without NACT were enrolled (3527 patients). A matched-case comparison design was used to compare the effects of NACT on lymph node metastasis.

Results: We analyzed groups of 167 and 140 patients who were diagnosed with lymph node metastasis in the matched primary surgery group and NACT group, respectively, and no significant difference was observed (p = 0.081). The incidence of lymph node metastasis was significantly decreased in the NACT-responsive group compared to the non-responsive group (18.4% vs. 38.6%, P<0.001). The metastatic rates for every lymph node group also declined in the NACT-responsive group except for the deep inguinal and the para-aortic lymph node groups. Clinical response, deep stromal, parametrial and lymph vascular invasions were independent risk factors for lymph node metastasis in the NACT group. Furthermore, deep stromal invasion and lymph vascular invasion, but not the response to NACT, were independently associated with upper LNM. The number of lymph nodes involved, response to NACT, tumor histology and a positive vaginal margin were independent prognostic factors affecting DFS or OS rates in node-positive patients treated with NACT plus radical surgery.

Conclusion: The frequency and topographic distribution of LNM are not modified by NACT, and clinical non-responders showed more involved LNs. A systemic and extensive lymphadenectomy should be performed in patients treated with NACT plus surgery regardless of the response to NACT.

Citing Articles

Early response to neoadjuvant chemotherapy can help predict long-term survival in patients with cervical cancer.

Li X, Huang K, Zhang Q, Shen J, Zhou H, Yang R Oncotarget. 2016; 7(52):87485-87495.

PMID: 27557523 PMC: 5350004. DOI: 10.18632/oncotarget.11460.

References

Lee J, Kim Y, Kim M, Kim K, Chung H, Park N . Treatment of stage IB2, IIA bulky cervical cancer: a single-institution experience of neoadjuvant chemotherapy followed by radical hysterectomy and primary radical hysterectomy. Arch Gynecol Obstet. 2010; 284(2):477-82. DOI: 10.1007/s00404-010-1685-9. View

Kim H, Kim J, Chung H, Kim H, Kim Y, Kim J . Significance of numbers of metastatic and removed lymph nodes in FIGO stage IB1 to IIA cervical cancer: Primary surgical treatment versus neoadjuvant chemotherapy before surgery. Gynecol Oncol. 2011; 121(3):551-7. DOI: 10.1016/j.ygyno.2011.01.024. View

Huang H, Liu J, Li Y, Wan T, Feng Y, Li Z . Metastasis to deep obturator and para-aortic lymph nodes in 649 patients with cervical carcinoma. Eur J Surg Oncol. 2011; 37(11):978-83. DOI: 10.1016/j.ejso.2011.08.128. View

Hu T, Li S, Chen Y, Shen J, Li X, Huang K . Matched-case comparison of neoadjuvant chemotherapy in patients with FIGO stage IB1-IIB cervical cancer to establish selection criteria. Eur J Cancer. 2012; 48(15):2353-60. DOI: 10.1016/j.ejca.2012.03.015. View

Ryu H, Chang K, Yang H, Kim M, Kwon H, Oh K . High cyclooxygenase-2 expression in stage IB cervical cancer with lymph node metastasis or parametrial invasion. Gynecol Oncol. 2000; 76(3):320-5. DOI: 10.1006/gyno.1999.5690. View

Ferrandina G, Lauriola L, Distefano M, Zannoni G, Gessi M, Legge F . Increased cyclooxygenase-2 expression is associated with chemotherapy resistance and poor survival in cervical cancer patients. J Clin Oncol. 2002; 20(4):973-81. DOI: 10.1200/JCO.2002.20.4.973. View

Park T, Kim S, Kwon J, Mo H . Postoperative adjuvant therapy in early invasive cervical cancer patients with histopathologic high-risk factors. Int J Gynecol Cancer. 2002; 11(6):475-82. DOI: 10.1046/j.1525-1438.2001.01057.x. View

. Neoadjuvant chemotherapy for locally advanced cervical cancer: a systematic review and meta-analysis of individual patient data from 21 randomised trials. Eur J Cancer. 2003; 39(17):2470-86. DOI: 10.1016/s0959-8049(03)00425-8. View

PILLERON J, Durand J, Hamelin J . Prognostic value of node metastasis in cancer of the uterine cervix. Am J Obstet Gynecol. 1974; 119(4):458-62. DOI: 10.1016/0002-9378(74)90201-4. View

10.

Inoue T, Morita K . The prognostic significance of number of positive nodes in cervical carcinoma stages IB, IIA, and IIB. Cancer. 1990; 65(9):1923-7. DOI: 10.1002/1097-0142(19900501)65:9<1923::aid-cncr2820650909>3.0.co;2-m. View

11.

Stehman F, Bundy B, Disaia P, Keys H, Larson J, Fowler W . Carcinoma of the cervix treated with radiation therapy. I. A multi-variate analysis of prognostic variables in the Gynecologic Oncology Group. Cancer. 1991; 67(11):2776-85. DOI: 10.1002/1097-0142(19910601)67:11<2776::aid-cncr2820671111>3.0.co;2-l. View

12.

Monk B, Cha D, Walker J, Burger R, Ramsinghani N, Manetta A . Extent of disease as an indication for pelvic radiation following radical hysterectomy and bilateral pelvic lymph node dissection in the treatment of stage IB and IIA cervical carcinoma. Gynecol Oncol. 1994; 54(1):4-9. DOI: 10.1006/gyno.1994.1157. View

13.

Scambia G, Benedetti Panici P, Foti E, Amoroso M, Salerno G, Ferrandina G . Squamous cell carcinoma antigen: prognostic significance and role in the monitoring of neoadjuvant chemotherapy response in cervical cancer. J Clin Oncol. 1994; 12(11):2309-16. DOI: 10.1200/JCO.1994.12.11.2309. View

14.

Namkoong S, Park J, Kim J, Bae S, Han G, Lee J . Comparative study of the patients with locally advanced stages I and II cervical cancer treated by radical surgery with and without preoperative adjuvant chemotherapy. Gynecol Oncol. 1995; 59(1):136-42. DOI: 10.1006/gyno.1995.1280. View

15.

Duk J, Groenier K, de Bruijn H, Hollema H, ten Hoor K, van der Zee A . Pretreatment serum squamous cell carcinoma antigen: a newly identified prognostic factor in early-stage cervical carcinoma. J Clin Oncol. 1996; 14(1):111-8. DOI: 10.1200/JCO.1996.14.1.111. View

16.

Benedetti-Panici P, Maneschi F, Scambia G, Greggi S, Cutillo G, DAndrea G . Lymphatic spread of cervical cancer: an anatomical and pathological study based on 225 radical hysterectomies with systematic pelvic and aortic lymphadenectomy. Gynecol Oncol. 1996; 62(1):19-24. DOI: 10.1006/gyno.1996.0184. View

17.

Sardi J, Giaroli A, Sananes C, Ferreira M, Soderini A, Bermudez A . Long-term follow-up of the first randomized trial using neoadjuvant chemotherapy in stage Ib squamous carcinoma of the cervix: the final results. Gynecol Oncol. 1997; 67(1):61-9. DOI: 10.1006/gyno.1997.4812. View

18.

Sakuragi N, SATOH C, Takeda N, Hareyama H, Takeda M, Yamamoto R . Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with Stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy. Cancer. 1999; 85(7):1547-54. DOI: 10.1002/(sici)1097-0142(19990401)85:7<1547::aid-cncr16>3.0.co;2-2. View

19.

Goff B, Muntz H, Paley P, Tamimi H, Koh W, Greer B . Impact of surgical staging in women with locally advanced cervical cancer. Gynecol Oncol. 1999; 74(3):436-42. DOI: 10.1006/gyno.1999.5472. View

20.

Henriksen E . The lymphatic spread of carcinoma of the cervix and of the body of the uterus; a study of 420 necropsies. Am J Obstet Gynecol. 1949; 58(5):924-42. DOI: 10.1016/0002-9378(49)90200-8. View