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2022-RA-1246-ESGO The impact on survival of FDG-TEP versus surgical pretherapeutic paraaortic lymph node staging in locally advanced cervical cancer before concomitant chemoradiation. A retrospective single-center cohort
  1. Houssein El Hajj1,
  2. Emilie Bogart2,
  3. Mehdi Benna1,
  4. Aurore Oudoux3,
  5. Luc Ceugnart4,
  6. Hortense Chevalier5,
  7. Delphine Hudry1,
  8. Florence Le Tinier6,
  9. Eric Leblanc1,
  10. Marie Cecile Le Deley2,
  11. Fabrice Narducci1,
  12. Abel Cordoba6 and
  13. Carlos Martinez Gomez1
  1. 1Department of Surgical Oncology, Centre Oscar Lambret, Lille, France
  2. 2Department of Statistics and Medical Research, Centre Oscar Lambret, Lille, France
  3. 3Department of Nuclear Medicine, Centre Oscar Lambret, Lille, France
  4. 4Department of Imaging, Centre Oscar Lambret, Lille, France
  5. 5Department of Medical Oncology, Centre Oscar Lambret, Lille, France
  6. 6Department of Radiotherapy, Centre Oscar Lambret, Lille, France


Introduction/Background Aortic lymph node (LN) involvement represents one of the essential prognosis factors and defines the extent of external definitive chemoradiation. Fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) remains the most accurate imaging technique to assess the extrauterine dissemination of the tumor unless it fails to detect between 10% to 15% of metastasis in aortic area. Despite false negatives of imaging, it remains unclear if surgical staging (SS) improves disease-free survival (DFS) and overall Survival (OS). We aim to determine the impact of SS on efficacy.

Methodology From 01/2009 to 12/2019, we retrospectively reviewed all consecutive patients (pts) addressed for brachytherapy diagnosed with locally advanced cervical cancer FIGO 2009 stages IB2-IVa with negative PET-CT uptake in the paraaortic area. OS and DFS were estimated from initial biopsy using the Kaplan-Meier method. Treatment effect of paraaortic and imaging LN staging (cohort 1) versus exclusive imaging staging (cohort 2) was estimated using Cox models adjusted on baseline characteristics which are significantly different between groups (age, BMI, diabetes, ECOG performance status, pelvic LN status, FIGO stage). Adjusted hazard ratio (adjHR) were estimated with 95% confidence interval (CI95%).

Results Among the 225 pts analyzed, 178 pts were in cohort 1 and 47 in cohort 2. Respectively for cohort 1 and 2, median age was 47 and 58 years, ECOG≥1 for 10 (6%) and 22 pts (47%) and FIGO stage ≥III for 72 (40%) and 29 pts (62%). Five-years OS was 79% (CI95%: 72–85) and 52% (36–65) respectively, with adjHR=0.71 (0.37–1.36) and p=0.30. Five-years DFS was 67% (60–74) and 42% (27–56), with adjHR=0.81 (0.47–1.42) and p=0.47.

Conclusion In this single-institution retrospective serie, SS appears not significantly different for OS and DFS compared to TEP-CT staging. However, the baseline characteristic of both groups was different. Prospective randomized trials should further evaluate the role of surgical staging.

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