Pretreatment Radiologically Enlarged Lymph Nodes as a Significant Prognostic Factor in Clinical Stage IIB Cervical Cancer: Evidence from a Taiwanese Tertiary Care Center in Reaching Consensus

Abstract

The incidence of lymph node (LN) involvement and its prognostic value based on radiological imaging in stage IIB cervical cancer (CC) remains unclear, and evidence regarding oncological outcomes of patients with stage IIB CC with LN metastases is limited. In this study we retrospectively reviewed the incidence and prognostic significance of pretreatment radiologic LN status in 72 patients with clinical stage IIB CC (FIGO 2009), with or without radiologic evidence of LN enlargement. An enlarged LN was defined as a diameter >10 mm on CT/MRI. Progression-free survival (PFS) and overall survival (OS) were assessed. Radiologic LN enlargement of >10 mm was observed in 45.8% of patients with stage IIB CC. PFS (p = 0.0088) and OS rates (p = 0.0032) were significantly poorer in the LN group (n = 33) than in the non-LN group (n = 39). Univariate Cox analysis revealed that LN > 10 mm contributed to a higher rate of recurrence and mortality. In conclusion, nearly half of the patients with clinical stage IIB CC had enlarged LNs (>10 mm) identified during pretreatment radiologic evaluation, which negatively impacted prognosis. Our findings highlight the need to incorporate CT- or MRI-based LN assessment before treatment for stage IIB CC.

The statistical significance may be misinterpreted

“…In our limited knowledge, stage may be the most importantly independent prognostic factors for all solid tumors. 2–5 In fact, the authors have clearly demonstrated the strong correlation between the high NLRP12 expression and advanced stage of intracranial glioma, suggesting that the expression of NLRP12 may depend on the tumor stage or vice versa.…”

Is it possible that advanced-stage gastric cancer patients can be cured by surgery alone?

“…We are wondering to know why GC patients with positive lymph node metastases could be classified as those who can be successfully by curative surgery (completely or totally resected tumors). Although we are not familiar with the staging system of GC, in our limited knowledge in the management of patients with gynecologic cancers, the presence of lymph node metastases is always considered the “systemic diseases.” 2–4 Additionally, a bigger tumor size classified by tumor node metastasis staging system above pT3-4 may have a higher risk of therapeutic failure when only curative surgery is applied, similar to the cervical cancer, 5 suggesting that it is not a better idea to use surgery alone in the management of patients with pT3-4 and/or N+ GC. In fact, the current NCCN guidelines recommend adjuvant treatment rather than surgery alone in patients with pT3-4 and/or N+ GC, 6 suggesting that only application of surgery alone for GC patients with pT3-4 and/or the presence of lymphadenopathy was at a higher risk of under treatment.…”

Neoadjuvant therapy

“…[2][3][4] An accurate and precise pretherapy evaluation and an appropriate and personalized therapeutic plan for these cancer or critically ill patients through the far-advanced development of new technology or therapeutic strategy, such as a minimally traumatic organ-preservation approach and a method for maintenance of physiological and morphological function of targeted lesions can minimize the risk of overtreatment and subsequently avoid the development of severe posttherapy sequelae without compromising the therapeutic efficacy. [5][6][7] To reach this goal, it is still challengeable. The recent publication in the Journal of the Chinese Medical Association entitled "The effect of Mitomycin-C in neoadjuvant concurrent chemoradiotherapy for rectal cancer" may be an example, since the authors investigated the possible benefit of using neoadjuvant therapy (NAT) using concurrent chemoradiotherapy (CCRT), called NAT-CCRT with adding mitomycin-C (called MMT+NAT-CCRT) in the management of patients with clinical T3, T4 or node-positive rectal adenocarcinoma staged (advanced-stage rectal cancer) by magnetic resonance image (MRI) or computed tomography (CT) compared to the NAT-CCRT group.…”