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    Hockel 2019

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    Hockel 2019

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    Hockel 2019

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    2/27/23, 1:37 AM Surgical resection based on ontogenetic cancer field theory for cervical cancer: mature results from

    esults from a single-centre, prospective, o…

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    Lancet Oncol. 2019 Sep;20(9):1316-1326. doi: 10.1016/S1470-2045(19)30389-4. Epub 2019 Aug 2.

    Surgical resection based on ontogenetic cancer field


    theory for cervical cancer: mature results from a
    single-centre, prospective, observational, cohort
    study
    Michael Höckel  1 , Benjamin Wolf  2 , Katja Schmidt  3 , Meinhard Mende  4 , Bahriye Aktas  2 , 
    Rainer Kimmig  5 , Nadja Dornhöfer  2 , Lars-Christian Horn  6

    Affiliations
    PMID: 31383547 DOI: 10.1016/S1470-2045(19)30389-4

    Abstract
    Background: Previous findings from our centre suggest that carcinoma of the cervix propagates
    within ontogenetic cancer fields, tissue compartments defined by staged morphogenesis. We aimed
    to determine whether surgical treatment that accounts for stage-associated, ontogenetic cancer fields
    and their associated lymphoid tissues results in locoregional tumour control without the need for
    adjuvant radiotherapy.

    Methods: We did the final clinical and histopathological evaluation of data from, the single-centre,
    observational, cohort study, the Leipzig School Mesometrial Resection Study. Patients of any age with
    stage IB1, IB2, IIA1, IIA2, or IIB cervical cancer (according to 2009 International Federation of
    Gynecology and Obstetrics [FIGO]) had total mesometrial resection or extended mesometrial
    resection and therapeutic lymph node dissection, done on the basis of ontogenetic cancer fields. We
    defined sentinel node, first-line, second-line, and third-line lymph node regions as progressive
    regional cancer fields. Primary outcomes were disease-specific survival and recurrence-free survival,
    and treatment-related morbidity (assessed with the Franco-Italian glossary). Applying Cox
    proportional hazard models, ontogenetic local (T) and regional (N) tumour staging was compared
    with pathological T and N staging. This trial is registered with the German Clinical Trials Register,
    number DRKS00015171.

    Findings: Between Oct 16, 1999, and June 27, 2017, 523 patients were treated per protocol and
    followed up for a median of 61·8 months (IQR 49·3-94·8). In 495 patients with cervical cancer treated
    with cancer field surgery, 5-year disease-specific survival was 89·4% (95% CI 86·5-92·4) and
    recurrence-free survival was 83·1% (79·7-86·6). In the per-protocol population of 523 patients,
    treatment-related morbidity comprised 112 (21%) grade 2 and 15 (3%) grade 3 complications. The
    most common moderate and severe treatment-related complications and sequelae were wound
    dehiscence (17 [3%]), hydronephrosis (17 [3%]), bowel obstruction (26 [5%]), and lymph oedema (33
    [6%]). One patient (<1%), who received total mesometrial resection, died from postoperative brain
    infarction.

    Interpretation: Total or extended mesometrial resection with therapeutic lymph node dissection
    based on ontogenetic cancer fields results in good survival outcomes of patients with cervical cancer
    in our institution, but needs to be investigated further in multicentre trials.

    Funding: Leipzig School of Radical Pelvic Surgery, University of Leipzig Medical School, and the
    Gynecologic Oncology Research Foundation.

    https://pubmed.ncbi.nlm.nih.gov/31383547/ 1/2
    2/27/23, 1:37 AM Surgical resection based on ontogenetic cancer field theory for cervical cancer: mature results from a single-centre, prospective, o…

    Copyright © 2019 Elsevier Ltd. All rights reserved.

    Comment in
    Radical surgery for cervical cancer.
    Raspagliesi F, Bogani G.
    Lancet Oncol. 2019 Sep;20(9):1198-1199. doi: 10.1016/S1470-2045(19)30409-7. Epub 2019 Aug 2.
    PMID: 31383546 No abstract available.

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    https://pubmed.ncbi.nlm.nih.gov/31383547/ 2/2

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