Burden of lymphatic disease predicts efficacy of adjuvant radiation and chemotherapy in FIGO 2018 stage IIICp cervical cancer

Abstract

ObjectiveNodal involvement is one of the most important prognostic factors in cervical cancer patients. We aimed to assess the prognostic role in relation to the burden of nodal disease in stage IIICp cervical cancer.MethodsData on all consecutive patients diagnosed with cervical cancer undergoing primary surgery (radical hysterectomy plus lymphadenectomy) or neoadjuvant chemotherapy followed by radical hysterectomy plus lymphadenectomy, between January 1980 and December 2017, were collected in a dedicated database. Exclusion criteria were: (1) consent withdrawal; (2) synchronous malignancies (within 5 years). Survival outcomes were assessed using Kaplan-Meier and Cox models.ResultsOverall, 177 (14.1%) of 1257 patients with cervical cancer were diagnosed with positive lymph nodes. After a median follow-up of 58 (range 4–175) months, 66 (37.3%) and 37 (20.9%) patients developed recurrent disease and died of disease, respectively. Via multivariate analysis, positive para-aortic nodes (HR 2.62, 95% CI 1.12 to 6.11; p=0.025) and the number of positive nodes (HR 1.06, 95% CI 1.02 to 1.11; p=0.002) correlated with worse disease-free survival. Furthermore, the number of positive nodes (HR 1.06, 95% CI 1.01 to 1.12; p=0.021) correlated with worse overall survival. Number of positive nodes (1, 2 or ≥3) strongly correlated with both disease-free survival (p<0.001, log-rank test) and overall survival (p=0.001, log-rank test). Focusing on patients receiving adjuvant radiation and chemotherapy, the number of positive lymph nodes was associated with response to treatment (p<0.001). Median disease-free survival was 100, 42, and 12 months for patients with one, two, or three or more positive lymph node(s), respectively (p<0.001, log-rank test).ConclusionsIn stage IIICp cervical cancer, adjuvant radiation and chemotherapy provides adequate overall survival in patients diagnosed with only one metastatic node, while survival outcomes are poor in patients with two or more metastatic nodes. This highlights the need for innovative treatments in patients with a high burden of lymphatic disease.

The Combination of T Stage and the Number of Pathologic Lymph Nodes Provides Better Prognostic Discrimination in Early-Stage Cervical Cancer With Lymph Node Involvement

“…All of the patients in our cohort had SCRT. It was satisfactory to have a 5-year OS of 92% for patients with T 1 N < 3 pLN in our cohort, which was comparable to that in the STARS study (23) and studies from Bogani et al (14) and Tim et al (25). From this point, radical surgery followed by SCRT was a reasonable treatment option for this group of patients.…”

“…On the other hand, Tsai et al (13) reported that patients with only one pLN had achieved similar outcomes compared to pN0, and patients with ≥ 2 pelvic pLNs had lower survival rates (87% vs. 61%, p < 0.001) than those with pN0. In the study from Bogani et al (14), median disease-free survival was 100, 42, and 12 months for patients with one, two, and three or more positive node(s), respectively. Kwon et al evaluated a group of 249 cervical cancer patients treated in 13 Korean institutions (15).…”

“…Several studies together showed that 5-year OS was equivalent between radical hysterectomy and radical CCRT, with different treatment-related morbidity in each group. Supplement Table 3 showed studies focused on early-stage cervical cancer with high risk factors; most of them were with positive LN (7,12,14,17,(22)(23)(24)(25)(26)(27)(28)(29). Radiotherapy was given after radical surgery in most of these studies, with variable combination of chemotherapy, such as CCRT, concurrent and consolidation chemotherapy, and SCRT (22-24, 30, 31).…”

Risk factors for nodal failure after radiochemotherapy and image guided brachytherapy in locally advanced cervical cancer: An EMBRACE analysis

“…Recent publications show that having multiple affected nodes at diagnosis is associated with a higher risk of development of nodal failure in LACC (34,35). In the EMBRACE I cohort we found that having affected nodes in multiple nodal regions was a strong risk factor for NF in descriptive analysis.…”

Smart Vitamin Micelles as Cancer Nanomedicines for Enhanced Intracellular Delivery of Doxorubicin

“…Chemotherapy uses anticancer drugs to destroy or inhibit the growth of cancer cells. It is one of the most effective treatments that improve cancer survival, and it can be given before and/or after surgery, either alone or in combination with other treatments, such as hormones [ 1 ], radiation [ 2 ], and immunotherapy [ 3 ]. However, intracellular delivery of anticancer drugs is hindered by their hydrophobicity and low molecular weight.…”