{"title":"Survival Benefit of Surgical Staging Before Radiotherapy in Locally Advanced Cervical Cancer: A Pooled Analysis","authors":"Huazhong Xu, Qu Zhang, Chengyan Luo, Mei Wang, Meng Tian, Xinchen Sun, Qin Qin","doi":"10.1111/cas.70136","DOIUrl":null,"url":null,"abstract":"<p>Lymph node metastasis significantly impacts prognosis and treatment in locally advanced cervical cancer (LACC). Surgical staging offers precise information on node involvement, though its survival benefit is debated. We pooled data from 9 cohort studies involving 2553 patients to evaluate the benefit of pre-treatment surgical staging in patients with locally advanced cervical cancer. Fixed effects models or random effects models were used to calculate the pooled hazard ratios (HRs). The overall pooled results showed no difference in PFS (HR 0.94, 95% CI 0.73–1.22, <i>p</i> = 0.65) or OS (HR 1.00, 95% CI 0.74–1.35, <i>p</i> = 0.99) between the two approaches of lymph node staging. However, the subgroup analyses found the PFS superiority of surgical staging in patients with FIGO stage II (HR 0.68, 95% CI 0.49–0.95, <i>p</i> = 0.02). Additionally, for the patients with no evidence of lymph node metastasis on imaging, surgical staging was associated with significantly improved PFS (HR 0.69, 95% CI 0.56–0.86, <i>p</i> = 0.001) and OS (HR 0.56, 95% CI 0.36–0.87, <i>p</i> = 0.01). In the subgroup of patients with suspicious bulky nodes on imaging, lymph node debulking-based surgical staging did not significantly improve either PFS (HR 0.97, 95% CI 0.72–1.31, <i>p</i> = 0.31) or OS (HR 1.16, 95% CI 0.68–1.99, <i>p</i> = 0.59) in comparison with imaging staging. Surgical staging may not be applicable to all patients with LACC. However, for the patients with FIGO II disease or those without suspicious lymph node involvement on imaging, node surgery staging could afford a survival benefit.</p><p><b>Trial Registration:</b> PROSPERO ID: CRD42024543768</p>","PeriodicalId":9580,"journal":{"name":"Cancer Science","volume":"116 9","pages":"2537-2546"},"PeriodicalIF":4.3000,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cas.70136","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancer Science","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/cas.70136","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Lymph node metastasis significantly impacts prognosis and treatment in locally advanced cervical cancer (LACC). Surgical staging offers precise information on node involvement, though its survival benefit is debated. We pooled data from 9 cohort studies involving 2553 patients to evaluate the benefit of pre-treatment surgical staging in patients with locally advanced cervical cancer. Fixed effects models or random effects models were used to calculate the pooled hazard ratios (HRs). The overall pooled results showed no difference in PFS (HR 0.94, 95% CI 0.73–1.22, p = 0.65) or OS (HR 1.00, 95% CI 0.74–1.35, p = 0.99) between the two approaches of lymph node staging. However, the subgroup analyses found the PFS superiority of surgical staging in patients with FIGO stage II (HR 0.68, 95% CI 0.49–0.95, p = 0.02). Additionally, for the patients with no evidence of lymph node metastasis on imaging, surgical staging was associated with significantly improved PFS (HR 0.69, 95% CI 0.56–0.86, p = 0.001) and OS (HR 0.56, 95% CI 0.36–0.87, p = 0.01). In the subgroup of patients with suspicious bulky nodes on imaging, lymph node debulking-based surgical staging did not significantly improve either PFS (HR 0.97, 95% CI 0.72–1.31, p = 0.31) or OS (HR 1.16, 95% CI 0.68–1.99, p = 0.59) in comparison with imaging staging. Surgical staging may not be applicable to all patients with LACC. However, for the patients with FIGO II disease or those without suspicious lymph node involvement on imaging, node surgery staging could afford a survival benefit.
淋巴结转移对局部晚期宫颈癌（LACC）预后和治疗有显著影响。手术分期提供了淋巴结受累的精确信息，尽管其生存效益存在争议。我们汇集了9项队列研究的数据，涉及2553例患者，以评估局部晚期宫颈癌患者治疗前手术分期的益处。采用固定效应模型或随机效应模型计算合并风险比（hr）。总体合并结果显示两种淋巴结分期方法的PFS （HR 0.94, 95% CI 0.73-1.22, p = 0.65）和OS （HR 1.00, 95% CI 0.74-1.35, p = 0.99）无差异。然而，亚组分析发现FIGO II期患者手术分期的PFS优势（HR 0.68, 95% CI 0.49-0.95, p = 0.02）。此外，对于影像学上没有淋巴结转移证据的患者，手术分期与PFS （HR 0.69, 95% CI 0.56-0.86, p = 0.001）和OS （HR 0.56, 95% CI 0.36-0.87, p = 0.01）的显著改善相关。在影像学上有可疑肿大淋巴结的患者亚组中，与影像学分期相比，基于淋巴结减容的手术分期并没有显著改善PFS （HR 0.97, 95% CI 0.72-1.31, p = 0.31）或OS （HR 1.16, 95% CI 0.68-1.99, p = 0.59）。手术分期可能并不适用于所有LACC患者。然而，对于FIGO II疾病患者或影像学上无可疑淋巴结累及的患者，淋巴结手术分期可提供生存益处。试验注册：PROSPERO ID: CRD42024543768。
期刊介绍：
Cancer Science (formerly Japanese Journal of Cancer Research) is a monthly publication of the Japanese Cancer Association. First published in 1907, the Journal continues to publish original articles, editorials, and letters to the editor, describing original research in the fields of basic, translational and clinical cancer research. The Journal also accepts reports and case reports.
Cancer Science aims to present highly significant and timely findings that have a significant clinical impact on oncologists or that may alter the disease concept of a tumor. The Journal will not publish case reports that describe a rare tumor or condition without new findings to be added to previous reports; combination of different tumors without new suggestive findings for oncological research; remarkable effect of already known treatments without suggestive data to explain the exceptional result. Review articles may also be published.
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