Therapeutic role of lymphadenectomy for cervical cancer

Authors

  • Monjri Shah MD,

    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
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  • Sharyn N. Lewin MD,

    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
    2. Herbert Irving Comprehensive Cancer Center, New York, New York
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  • Israel Deutsch MD,

    1. Herbert Irving Comprehensive Cancer Center, New York, New York
    2. Department of Radiation Oncology, Columbia University College of Physicians and Surgeons, New York, New York
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  • William M. Burke MD,

    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
    2. Herbert Irving Comprehensive Cancer Center, New York, New York
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  • Xuming Sun MS,

    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
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  • Thomas J. Herzog MD,

    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
    2. Herbert Irving Comprehensive Cancer Center, New York, New York
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  • Jason D. Wright MD

    Corresponding author
    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
    2. Herbert Irving Comprehensive Cancer Center, New York, New York
    • Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Ave, 8th Floor, New York, NY 10032
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    • Fax: (212) 305-3412


Abstract

BACKGROUND.

Despite the diagnostic value of lymphadenectomy for early-stage cervical cancer, its therapeutic role is unknown. We examined the therapeutic potential of extensive lymphadenectomy in women with early-stage cervical cancer.

METHODS.

Women with stage IA2-IIA cervical cancer who underwent radical hysterectomy with lymphadenectomy in the Surveillance, Epidemiology, and End Results (SEER) database were analyzed. Patients were stratified according to the number of nodes removed. The effect of the extent of lymphadenectomy on overall and cancer-specific survival was examined using multivariable Cox proportional hazards models. Separate analyses were performed for node positive and node negative patients.

RESULTS.

Among 5522 women, 893 (16%) had <10 nodes, 2030 (37%) had 11-20, 1487 (27%) had 21-30 nodes, and 1112 (20%) had >30 nodes removed. Black women, those >65 years of age and those diagnosed later in the study, were less likely to have 10 or more nodes removed (P < .05 for all). Among women with positive lymph nodes, a more extensive lymphadenectomy had no effect on survival (HR = 0.75; 95% CI, 0.47-1.22). For women with negative lymph nodes, a more extensive lymphadenectomy was associated with improved survival. Compared with node negative patients with less than 10 nodes removed, patients with 21-30 nodes removed were 24% (HR = 0.76; 95% CI, 0.53-1.09) less likely to die, whereas those with >30 nodes removed were 37% (HR = 0.64; 95% CI, 0.43-0.96) less likely to die from their tumors.

CONCLUSIONS.

Node negative, early-stage cervical cancer patients who undergo a more extensive lymphadenectomy have an improved survival. Cancer 2011. © 2010 American Cancer Society.

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