Main Session
Sep
29
PQA 06 - Genitourinary Cancer, Gynecological Cancer, and Health Care Access and Engagement
3801 - Impact of Laparoscopic Surgeries Prior to Definitive Chemoradiation for Cervical Cancer on Risk of Cancer Progression: A U.S. Healthcare Claims Database Analysis
Presenter(s)
Emily Smith, MD - Stanford Health Care, Stanford, CA
E. J. Smith1, M. Xiang2, B. Litkouhi3, Y. C. T. Shih2, and E. A. Kidd4; 1Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, 2Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, 3Department of Gynecologic Oncology, Stanford University School of Medicine, Stanford, CA, 4Department of Radiation Oncology, Stanford University, Stanford, CA
Purpose/Objective(s):
For Stage IA1-IB1 cervical cancer, the Laparoscopy Approach for Cervical Cancer trial reported worse overall survival with laparoscopic vs. open abdominal hysterectomy. While the mechanism for this is not clear, one hypothesis was that the CO2 insufflation with laparoscopy may disseminate malignant cells throughout the peritoneal cavity and promote cell proliferation. In vitro studies found that CO2 exposure transiently increases the proliferation rate of cervical cancer cells and insufflation may alter the peritoneal lining and promote intraabdominal metastases. While patients undergoing definitive chemoradiation (chemoRT) for locally advanced cervical cancer do not undergo hysterectomies, a subset undergo prior laparoscopic surgery, such as ovarian transposition (OT) or lymph node dissection (LND). We aim to evaluate the impact of laparoscopic surgery prior to definitive chemoRT on the risk of cancer progression.Materials/Methods:
Using the MarketScan Research databases, which includes claims and enrollment data for employer-sponsored commercial insurance, Medicare for retirees, and Medicaid from 2010-2024, we identified patients with a cervical cancer diagnosis treated with definitive chemoRT, defined as 20-35 external beam radiation therapy (EBRT) claims followed by at least 3 brachytherapy claims within 90 days of the first EBRT claim, with at least one chemotherapy claim within 30 days before or 90 days after the first EBRT claim and no claim for hysterectomy. The laparoscopy cohort was defined as having a claim for laparoscopic OT and/or LND. Progression was defined as a chemotherapy claim or diagnosis codes for secondary malignant neoplasms more than 180 days after the first EBRT claim. Statistical analysis included Kaplan-Meier analyses for freedom from progression (FFP) and univariable and multivariable Cox regressions.Results:
A total of 4322 patients were identified, of whom 211 underwent laparoscopic OT, LND, or both. The laparoscopy cohort had significantly worse FFP (p < 0.0001), with 2-year FFP of 35% vs. 53% in the no laparoscopy cohort. Univariable analysis showed that laparoscopy had an increased hazard ratio (HR 1.49) for progression (95% CI 1.23-1.81; p<0.0001), which persisted on multivariable analysis adjusting for age and year of diagnosis. When separating the laparoscopy cohort into OT only (n = 21), LND only (n = 170), or both (n = 20), the LND+OT group had the worst FFP of 19% at 2 years vs. 31% in LND only group and 83% in the OT only group.Conclusion:
Cervical cancer patients treated with definitive chemoRT who had a prior laparoscopic OT and/or LND had significantly worse FFP than those who did not undergo a prior laparoscopy. With the lack of staging and survival information in this database, these results are hypothesis-generating and further studies are needed to validate these findings.