Impact of surgical staging in locally advanced cervical cancer and subsequent chemotherapy.
BACKGROUND
Surgical staging (SS) is the gold standard for determination of the true extent of a patient's disease and is an important prognostic factor in cervical cancer. We investigated whether lymph node dissection (LND) prior to chemotherapy (CT) followed by radical surgery (RS) could modified overall (OS) and disease-free survival (DFS).


METHODS
We performed a cohort analysis of 98 patients with cervical carcinoma. The experimental group consisted of 36 patients who underwent SS followed by neoadjuvant chemotherapy, and then by RS (objective response) or chemo-radiation therapy (with or without subsequent surgery when not possible). The control group consisted of 62 similarly treated patients without pretreatment SS. The value of this procedure as a diagnostic tool in defining the extent of disease was evaluated. Furthermore, LND/CT-associated treatment complications and the impacts on OS and DFS were also evaluated.


RESULTS
Fourteen (38.9%) patients had pelvic LN metastases and three (8.3%) patients had pelvic and para-aortic LN metastases. The 39-month OS and DFS rates for the current study were 80.6% for the staged group and 52% for non-staged treatment (P < 0.001).


CONCLUSIONS
SS in cervical cancer is a feasible and safe pretreatment procedure, and when associated with CT, it improves OS and DFS.
Marana
Heitor Ricardo Cosiski
HR
Oncology Section, Department of Gynecology and Obstetrics, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. marana@keynet.com.br
de Andrade
Jurandyr Moreira
JM
Dos Reis
Francisco José Cândido
FJ
Tiezzi
Daniel Guimarães
DG
Zola
Fábio Eduardo
FE
Clagnan
Willan Simões
WS
Garieri
Alexandre Pavan
AP
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D016022:Case-Control Studies; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy
D002945:Cisplatin; D005472:Fluorouracil