Article Text
PDF
Abstract
Introduction/Background The use of pelvic exenteration (PE) for locally advanced gynecological cancer or local recurrence is sometimes the only possible treatment. Because of the impact of this major surgery, our objective was to identify prognostic factors in order to establish an operative prognostic score.
Methodology Patients were characterized by age, type of PE (anterior, posterior, total, atypical, preservation of pelvic floor and perineal excision, extended or not to other structures), indication, curative or palliative surgery and prior radiation therapy.
Results Over 30 years, 277 patients were included. Overall survival at 3 and 5 years was 36.8% and 32.3%. The rate of non-curative resection was significantly correlated with posterior PE (OR: 2.29), tumors developed in lateral pelvic (OR: 2.91), PE requiring enlargement (OR: 2.61) and lack of radiotherapy or <45 Gy (OR: 1.73). In multivariate analysis, factors impacting significantly on survival were: total PE (HR: 2.04, p<0.0001), extended PE (HR: 1.56, p=0.017) and lack of radiotherapy or <45 Gy (HR: 1.40; p=0.033).Based on these factors, we created 4 differents groups in order to establish a pre and post-operative prognostic score. Overall 5-year survival for each group was respectively 48.7%, 29.0%, 28.7% and 14.8% (p<0.0001). A preoperative high score was a strong negative predictive predictor on overall survival (HR=3.01, p<0.0001).
Conclusion These scores could help to predict the overall survival and to decide when it would be necessary to perform this surgery.
Disclosure Nothing to disclose.
How to calculate the pre operative prognostic predictive scoreAccuracy of this preoperative prognostic score is reported by an AUC of 0.611, p=0.007. *post operative mortality excluded
Overall survival curves according to pre operative and post operative prognostic score