Type B versus Type C Radical Hysterectomy After Neoadjuvant Chemotherapy in Locally Advanced Cervical Carcinoma: A Propensity-Matched Analysis
- 289 Downloads
The aim of this study was to evaluate the feasibility and safety of type B radical hysterectomy (RH) in the management of patients affected by locally advanced cervical cancer with favorable prognostic factors (tumor diameter <40 mm, negative nodes, or lymphovascular space involvement) and clinical response to neoadjuvant chemotherapy (NACT).
The data of women undergoing platinum-based NACT followed by RH plus bilateral systematic pelvic lymphadenectomy were collected. Patients undergoing type B RH (Group A) were compared with those undergoing type C RH (Group B); a propensity-matched comparison (1:1) was carried out to minimize selection biases. Postoperative complications were reported and 5-year survival outcomes were assessed using the Kaplan–Meier model.
Thirty-six node-negative patients undergoing type B RH (Group A) were compared with 36 propensity-matched patients undergoing type C RH (Group B). The bladder dysfunction rate was significantly lower in Group A compared with Group B (13.9 vs. 69.4 %; p < 0.0001), and no statistically significant difference in 5-year overall survival (OS) and disease-free survival (DFS) between groups was reported (OS 93.0 vs. 96.7 %, p = 0.42; DFS 88.6 and 85.5 %, p = 0.77).
Type B RH after NACT in well-selected patients is a safe procedure that upholds the results of type C, reducing operative time and late postoperative morbidity, without detrimental effect on survival. Further prospective trials are warranted to confirm our results on a large scale.
KeywordsOverall Survival Cervical Cancer Propensity Score Radical Hysterectomy Favorable Prognostic Factor
- 4.Neoadjuvant Chemotherapy for Cervical Cancer Meta-Analysis Collaboration (NACCCMA) Collaboration. Neoadjuvant chemotherapy for locally advanced cervix cancer. Cochrane Database Syst Rev. 2004;(2):CD001774.Google Scholar
- 7.Piver S, Rutledge F, Smith JP. Five classes of extended hysterectomy. Am J Obstet Gynecol. 1974;44:265–72.Google Scholar
- 10.Benedetti Panici P, Angioli R, Palaia I, Muzii L, Zullo MA, Manci N, et al. Tailoring the parametrectomy in stages IA1-IB1 cervical carcinoma: is it feasible and safe? Gynecol Oncol. 2005;96:792–8.Google Scholar
- 12.Benedetti Panici P, Manci N, Di Donato et al. Vaginectomy: a minimally invasive treatment for cervical cancer vaginal recurrence. Int J Gynecol Cancer. 2009;19(9):1625–31.Google Scholar
- 13.Benedetti Panici P, Zullo MA, Plotti F, Manci N, Muzii L, Angioli R. Long-term bladder function in patients with locally advanced cervical carcinoma treated with neoadjuvant chemotherapy and type 3-4 radical hysterectomy. Cancer. 2004;100: 2110–7.Google Scholar
- 15.Benedetti Panici P, Maneschi F, D’Andrea G, et al. Early cervical carcinoma: the natural history of lymph node involvement redefined on the basis of thorough parametrectomy and giant section study. Cancer. 2000;88(10):2267–74.Google Scholar
- 18.Papadia A, Bellati F, Bogani G, Ditto A, Martinelli F, Lorusso D, et al. When does neoadjuvant chemotherapy really avoid radiotherapy? Clinical predictors of adjuvant radiotherapy in cervical cancer. Ann Surg Oncol. 2015.Google Scholar