title: Incidence of Histologically Proven Pelvic and Para-Aortic Lymph Node Metastases and Rate of Upstaging in Patients with Locally Advanced Cervical Cancer: Results of a Prospective Randomized Trial.
abstract: BACKGROUND
  Surgical staging is associated with a significant rate of upstaging compared to clinical/radiological staging in patients with locally advanced cervical cancer.
  
  
  OBJECTIVE
  To analyze the stage-specific percentage of pelvic and para-aortic lymph node metastases and the upstaging ratio in a prospective randomized trial (Uterus-11).
  
  
  METHODS
  FIGO stage IIB-IVA cervical cancer patients were randomized to surgical staging (arm A) or to clinical staging and primary chemoradiation (arm B). Arm B patients underwent CT-guided biopsy of suspicious para-aortic lymph nodes. Confirmed para-aortic metastasis patients received extended-field radiation therapy.
  
  
  RESULTS
  A total of 234 patients were enrolled, including 120 (arm A) and 114 (arm B) treated per protocol. The groups were well balanced. Pelvic and para-aortic lymph node metastases were identified after surgical staging in 51 and 24% of patients, respectively (p < 0.001). Pelvic and para-aortic lymph node metastases were confirmed in 45 and 20% of IIB patients and in 71 and 37% of IIIB patients, respectively. Upstaging occurred in 39/120 (33%) in arm A and in 9/114 (8%) in arm B (p < 0.001).
  
  
  CONCLUSIONS
  The histological results in both groups led to a considerable rate of upstaging. Oncological data from the Uterus-11 study may reveal whether modified therapy translates into a survival benefit.
authors.affiliation: Gynecologic Oncology Department, Hospital Erasto Gaertner and Instituto de Oncologia do Paraná, Curitiba, Brazil.
authors.forename: Audrey Tieko
authors.initials: AT
authors.lastname: Tsunoda
authors.forename: Simone
authors.initials: S
authors.lastname: Marnitz
authors.forename: Joao
authors.initials: J
authors.lastname: Soares Nunes
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Mattos de Cunha Andrade
authors.forename: Christovam
authors.initials: C
authors.lastname: Scapulatempo Neto
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Blohmer
authors.forename: Jörg
authors.initials: J
authors.lastname: Herrmann
authors.forename: Ligia Maria
authors.initials: LM
authors.lastname: Kerr
authors.forename: Peter
authors.initials: P
authors.lastname: Martus
authors.forename: Achim
authors.initials: A
authors.lastname: Schneider
authors.forename: Giovanni
authors.initials: G
authors.lastname: Favero
authors.forename: Christhardt
authors.initials: C
authors.lastname: Köhler
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010386:Pelvic Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000556:secondary; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D055815:Young Adult