Prognostic impact of para-aortic surgical staging in stage IIIC1 cervical cancer according to the FIGO 2018 classification
To assess overall survival in stage IIIC1 cervical cancer patients (International Federation of Gynecology and Obstetrics 2018 classification) comparing those with and without para-aortic surgical staging, and, secondarily, to evaluate disease-free survival. This multi-center retrospective study used the FRANCOGYN cohort, covering 12 French institutions and including 2410 patients diagnosed from January 1996 to December 2023. Inclusion criteria were: patients with stage IIIC1 cervical cancer and pelvic lymph node involvement identified by positron emission tomography-computed tomography, histology, or magnetic resonance imaging. Exclusion criteria were: neuroendocrine carcinomas, unavailable imaging, lymph nodes less than 10 mm in diameter on magnetic resonance imaging, and therapeutic management not following practice guidelines. The Kaplan-Meier method was used to estimate survival distribution. A Cox proportional hazards model was used to account for the influence of multiple variables. Out of 279 patients, 189 (67.7%) underwent para-aortic surgical staging, while 90 (32.3%) did not. The mean age was 51.5 ± 12.3 years, and most patients had squamous cell carcinoma (81.7%). Patients who underwent surgical staging were younger, had lower body mass index, and had smaller primary tumor size. The mean follow-up was 38.8 months (IQR, 14.6-56.8). Positive para-aortic lymph nodes were found in 39 patients (20.9%). There was no significant survival improvement with para-aortic staging for overall survival (HR 0.70, 95% CI 0.36 to 1.37) or disease-free survival (HR 0.81, 95% CI 0.49 to 1.33). Perioperative complications occurred in 14.8% of cases (3.7% intraoperative and 11.1% post-operative). The most frequent post-operative complication was lymphocele, while ventilatory complications with hypercapnia were the most common intraoperative events. Our study found no significant survival benefit for para-aortic surgical staging compared to radiologic staging in patients with stage IIIC1 cervical cancer. These results challenge the principle of surgical staging in this patient population.