title: Survival effect of laparoscopic para-aortic staging in locally advanced cervical cancer: a retrospective cohort analysis.
abstract: OBJECTIVE
  This study compares two methods of evaluating para-aortic node involvement in locally advanced cervical cancer (LACC) in order to define external radiotherapy treatment fields: laparoscopic surgical para-aortic lymphadenectomy or PET-CT imaging.
  
  
  METHODS
  We selected 187 patients with LACC who had been treated by chemoradiation therapy in two comprehensive cancer centres from January 2001 to December 2013. A total of 98 underwent para-aortic evaluation by PET-CT (Centre 1) and 89 received surgical laparoscopic excision (Centre 2).
  
  
  METHODS
  All patients with LACC were retrospectively collected in each centre. OS and DFS were calculated using the Kaplan-Meier's method and survival curves were compared using log-rank test.
  
  
  METHODS
  Outcomes were the comparison of patients' disease-free (DFS) and overall survival (OS) between the two centres.
  
  
  RESULTS
  Patients had a significantly better disease-free survival in cohort 1 than in cohort 2, at 2 years [80.9% (71.7-87.5) versus 57.1% (46.1-67.3)] and at 5 years [70.5% (58.8-79.9) versus 49.2% (38.2-60.4)] (P = 0.009). These results are confirmed by multivariate analysis model [hazard ratio (HR) 1.93; 95% CI 1.03-3.61; P = 0.04]. The overall survival was also better in cohort 1, both at 2 and 5 years [93.5% (86.5-97.0) versus 78.5% (68.5-86.0) and 85.1% (73.2-92.2) versus 63.8% (51.9-74.2), respectively; P = 0.006]. The multivariate analysis model found concordant results with an increased relative risk of death for patients treated in cohort 2 (HR 2.55; 95% CI 1.09-5.99; P = 0.01).
  
  
  CONCLUSIONS
  In this retrospective cohort analysis, para-aortic surgical staging in LACC is more deleterious for patients than is radiological staging in terms of OS and DFS.
  
  
  CONCLUSIONS
  Para-aortic surgical staging in LACC is more deleterious for patients than clinical staging.
authors.affiliation: Department of Surgical Oncology, CRLCC Jean Perrin, Clermont-Ferrand, France.|UMR Inserm 990 IMTV, Université d'Auvergne, Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Pomel
authors.affiliation: Department of Surgical Oncology, Institut Universitaire du Cancer-Oncopole, Toulouse, France.
authors.forename: A
authors.initials: A
authors.lastname: Martinez
authors.affiliation: Department of Surgical Oncology, CRLCC Jean Perrin, Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Bourgin
authors.affiliation: Department of Surgical Oncology, CRLCC Jean Perrin, Clermont-Ferrand, France.
authors.forename: M
authors.initials: M
authors.lastname: Beguinot
authors.affiliation: Department of Radiotherapy, CRLCC Jean Perrin, Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Benoit
authors.affiliation: Gynaecological Oncology, Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK.
authors.forename: R
authors.initials: R
authors.lastname: Naik
authors.affiliation: Department of Surgical Oncology, CRLCC Jean Perrin, Clermont-Ferrand, France.
authors.forename: J
authors.initials: J
authors.lastname: Dauplat
authors.affiliation: Department of Surgical Oncology, CRLCC Jean Perrin, Clermont-Ferrand, France.
authors.forename: G
authors.initials: G
authors.lastname: Lebouedec
authors.affiliation: Department of Surgical Oncology, Institut Universitaire du Cancer-Oncopole, Toulouse, France.
authors.forename: G
authors.initials: G
authors.lastname: Ferron
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005602:France; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery
keywords: Cervical cancer; external field radiotherapy; imaging para-aortic staging; laparoscopic para-aortic staging