The COREPEX study, a large multicenter international analysis of 862 patients , evaluated survival, recurrence, and prognostic factors after pelvic exenteration for cervical, vaginal, vulvar, or endometrial cancers. At curative intent, total pelvic exenteration, positive surgical margins, and lymphovascular space invasion were independently associated with worse disease-free survival (DFS) and overall survival (OS) , while lymphadenectomy improved DFS. Patients operated for persistent disease fared worse than those treated for recurrence.
Based on multivariable analysis, a prognostic score stratified patients into four risk groups, with 5-year DFS ranging from 43.7% down to 8.0% and OS from 54.3% down to 4.3% (P<.001) . Distant recurrence was most frequent ( 32.1% ), and para-aortic lymph node metastasis predicted significantly poorer outcomes than pelvic-only or node-negative disease.…
