PT  - JOURNAL ARTICLE
AU  - Natsuo Tomita
AU  - Mika Mizuno
AU  - Shinji Kondo
AU  - Masahiko Mori
AU  - Sho Takeshita
AU  - Jun Sakata
AU  - Hirofumi Tsubouchi
AU  - Takeshi Kodaira
TI  - Role of Extensive Lymphadenectomy in Early-Stage Cervical Cancer Patients With Radical Hysterectomy Followed by Adjuvant Radiotherapy
AID  - 10.1097/IGC.0000000000001279
DP  - 2018 Jun 01
TA  - International Journal of Gynecologic Cancer
PG  - 1211--1217
VI  - 28
IP  - 6
4099  - http://ijgc.bmj.com/content/28/6/1211.short
4100  - http://ijgc.bmj.com/content/28/6/1211.full
SO  - Int J Gynecol Cancer2018 Jun 01; 28
AB  - Objectives The objective of this study was to assess the effect of extensive lymphadenectomy on survival of early-stage cervical cancer patients with radical hysterectomy followed by adjuvant radiotherapy (RT).Materials and Methods A retrospective analysis was performed on early-stage patients with high-risk factors who received radical hysterectomy with lymphadenectomy followed by adjuvant RT. All patients were divided into the less than or equal to 40 dissected pelvic lymph nodes (DPLN ⩽40) and greater than 40 dissected pelvic lymph nodes (DPLN >40) groups to assess the effect of extensive lymphadenectomy. Distributions of disease-free survival (DFS) and overall survival (OS) were calculated by the Kaplan-Meier method. Significance of survival was assessed by the log-rank test. Cox proportional hazards models were applied to assess the effects of the factors on survival by univariate and multivariate analyses.Results After a median follow-up of 76 months for a total of 178 patients, 5-year DFS of the DPLN >40 group was significantly higher than that of the DPLN ⩽40 group (86% vs 74%, P = 0.045). Five-year OS was comparable between the 2 groups (85% vs 78%, P = 0.49). The multivariate analysis showed that the DPLN ⩽40 group was at a significantly higher risk of recurrence (hazard ratio, 2.3; 95% confidence interval (CI), 1.1–4.8; P = 0.020), whereas OS was not affected by the DPLN group (P = 0.26). Positive pelvic lymph node, parametrial invasion, histological type, and the absence of RT-combined chemotherapy remained significant prognostic factors for lower DFS and OS by the multivariate analysis. Adjusted hazard ratio of DPLN ⩽40 for DFS was 1.2 (95% CI, 0.11–12; P = 0.91) in patients with negative pelvic lymph node (PLN) whereas it was 2.6 (95% CI, 1.1–5.8; P = 0.024) in patients with positive PLN.Conclusions These results suggest that more extensive lymphadenectomy significantly improve the outcomes of patients with positive PLN even followed by adjuvant RT.