Impact of para-aortic lymphadenectomy on prognosis and quality of life in preoperative IB2-IIA2 cervical cancer: A multi-center cohort study.

5528 Background: The indication of para-aortic lymphadenectomy (PALD) in preoperative IB2-IIA2 (FIGO 2018) cervical cancer remains unclear. We aimed to access the impact of PALD on the prognosis and life quality in preoperative IB2-IIA2 cervical cancer patients. Methods: This cohort study, a target trial emulation, was conducted at the Obstetrics and Gynecology Hospital of Fudan University, including cervical cancer patients with a preoperative stage of IB2-IIA2 from 2019 to 2023 (clinical trial ChiCTR2400092255). Propensity score matching at a 1:1 ratio (PALD versus non-PALD) was applied to balance baseline characteristics. Primary outcomes were progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS). Secondary outcomes included perioperative complications and adverse events (AEs). Kaplan-Meier and subgroup analyses were conducted, and Cox proportional hazard models were established. External validation was performed at another three tertiary hospitals in China. Results: Of the 2609 patients included, 683 (26.2%) underwent PALD during radical surgery. Propensity score matching yielded a cohort of 1250 patients with balanced covariates. Patients who underwent PALD demonstrated similar PFS (hazard ratio 1.27; 95% CI, 0.89-1.80; P=0.188), OS (hazard ratio 1.17; 95% CI, 0.71-1.93; P=0.544), and CSS (hazard ratio 1.20; 95% CI, 0.70-2.06; P=0.512) as those who did not. Additionally, no significant differences were detected in survival associated with receiving PALD among subgroups defined by lymph node status based on preoperative imaging, the para-aortic lymph node (PALN) metastasis prediction model, and other postoperative pathological risk factors. External validation drew consistent conclusions regarding the effect of PALD on survival. Moreover, the PALD group compared with non-PALD group showed more intraoperative hemorrhage (P=0.005), longer operation time (P=0.004), and a higher tendency for chylous fistula (P=0.077). Conclusions: PALD, compared with non-PALD, was not associated with survival benefits for IB2-IIA2 cervical cancer patients yet was associated with increased surgical complications.