Radiographic Number of Positive Pelvic Lymph Nodes as a Prognostic Factor in Cervical Cancer Treated With Definitive Concurrent Chemoradiotherapy or Intensity-Modulated Radiotherapy

Abstract

Background: This study aims to assess the prognostic significance of radiographic numbers of positive pelvic lymph nodes (PLNs) in patients with cervical cancer treated with definitive concurrent chemoradiotherapy (CCRT) or intensity-modulated radiotherapy (IMRT).Methods: We conducted a retrospective study that included 164 eligible adult patients with cervical cancer who were treated with definitive CCRT or IMRT at our institution from 2009 to 2016. After exclusion of 50 patients, a total of 114 patients whose clinicopathological data and follow-up were finally analyzed. The radiographic numbers of positive PLNs were assessed by pretreatment magnetic resonance imaging (MRI) or computed tomography (CT). The criterion for a positive lymph node was defined as a short-axis diameter >1 cm. Using the Kaplan–Meier method and the Cox proportional hazards regression model, we assessed the overall survival (OS), cancer-specific survival (CSS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRFS).Results: The median follow-up duration was 40 (range: 2–100) months. For patients with 0, 1–2, and ≥3 positive PLNs, the estimated 3-year OS were 85.4% vs. 82.4% vs. 59.7% (p = 0.035), CSS were 90.1% vs. 86.1% vs. 62.9% (p = 0.010), DMFS were 89.4% vs. 91.3% vs. 49.6% (p < 0.001), and LRFS were 77.8% vs. 73.4% vs. 70% (p = 0.690). Per the multivariate Cox regression, positive PLNs ≥3 (HR, 2.51; 95% CI: 1.09–5.80; p = 0.031) and non-squamous cell carcinoma type (HR, 2.82; 95% CI: 1.19–6.69; p = 0.018) were unfavorable factors for the OS. Besides, positive PLNs ≥3 was the independent factor for the CSS (HR, 3.38; 95% CI: 1.32–8.67; p = 0.011) and DMFS (HR, 6.83; 95% CI: 2.62–17.83; p < 0.001). The patients that were treated without intracavitary brachytherapy exhibited inferior LRFS (HR, 13.15; 95% CI: 2.66–65.10; p = 0.002).Conclusions: The radiographic number of positive PLNs (≥ 3) is an independent prognostic factor for OS, CSS, and DMFS in patients treated with definitive CCRT or IMRT.

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

“…In particular, patients with 0, 1–2, and ≥3 suspected positive nodes experienced a 3 year overall survival of, respectively, 85.4% vs 82.4% vs 59.7% (p=0.035) 13. The radiographic number of suspected positive nodes ≥3 is an independent prognostic factor for overall survival, also at multivariate analysis 13. Here, our investigation corroborated these findings, investigating the role of pathological positive nodes in a larger group of patients.…”

“…In the present study we observed that, in addition to the presence of positive nodes, the number of positive nodes had an impact on patient outcomes, thus adding new information useful for assessing patient prognosis. Other investigators observed similar results focusing on patients with suspected positive nodes at radiological examination 13–15. Wang et al conducted a retrospective study that included 114 patients undergoing radiotherapy (with or without chemotherapy) for cervical cancer.…”

“…The radiographic numbers of suspected positive nodes (assessed by pre-treatment MRI or CT) correlated with survival outcomes. In particular, patients with 0, 1–2, and ≥3 suspected positive nodes experienced a 3 year overall survival of, respectively, 85.4% vs 82.4% vs 59.7% (p=0.035) 13. The radiographic number of suspected positive nodes ≥3 is an independent prognostic factor for overall survival, also at multivariate analysis 13.…”

Comparison of different lymph node staging systems in patients with node-positive cervical squamous cell carcinoma following radical surgery

“…In recent years, the relationship between PLNs and the prognosis of cervical cancer patients has been clarified. In a study by Wang et al, patients treated with definitive concurrent chemoradiotherapy (CCRT) or intensity-modulated radiotherapy (IMRT) were included, and their results confirmed that the presence of PLNs (≥ 3) was an independent prognostic factor for OS, cancer-specific survival (CSS), and distant metastasis-free survival (DMFS) 17 . Similarly, Kwon et al also found that PLNs were associated with DMFS and disease-free survival (DFS) in patients with early-stage cervical cancer.…”

“…Different studies have selected different cutoff values when using the PLN system as the staging method 17 - 19 . In this study, we used the method of tree-based recursive partitioning, which can help select the parameters that provide the optimal split for censored data 30 .…”