The Prognostic Impact of the Number of Metastatic Lymph Nodes and a New Prognostic Scoring System for Recurrence in Early-Stage Cervical Cancer with High Risk Factors: A Multicenter Cohort Study (KROG 15-04)

Abstract

PurposeWe aimed to assess prognostic value of metastatic pelvic lymph node (mPLN) in early-stage cervical cancer treated with radical surgery followed by postoperative chemoradiotherapy. Also, we sought to define a high-risk group using prognosticators for recurrence.Materials and MethodsA multicenter retrospective study was conducted using the data from 13 Korean institutions from 2000 to 2010. A total of 249 IB-IIA patients with high-risk factors were included. We evaluated distant metastasis-free survival (DMFS) and disease-free survival (DFS) in relation to clinicopathologic factors including pNstage, number of mPLN, lymph node (LN)ratio (number of positive LN/number of harvested LN), and log odds of mPLNs (log(number of positive LN+0.5/number of negative LN+0.5)).ResultsIn univariate analysis, histology (squamous cell carcinoma [SqCC] vs. others), lymphovascular invasion (LVI), number of mPLNs (≤ 3 vs. > 3), LN ratio (≤ 17% vs. > 17%), and log odds of mPLNs (≤ ‒0.58 vs. > ‒0.58) were significant prognosticators for DMFS and DFS. Resection margin involvement only affected DFS. No significant survival difference was observed between pN0 patients and patients with 1-3 mPLNs. Multivariate analysis revealed that mPLN > 3, LVI, and non-SqCC were unfavorable index for both DMFS (p < 0.001, p=0.020, and p=0.031, respectively) and DFS (p < 0.001, p=0.017, and p=0.001, respectively). A scoring system using these three factors predicts risk of recurrence with relatively high concordance index (DMFS, 0.69; DFS, 0.71).ConclusionmPLN > 3 in early-stage cervical cancer affects DMFS and DFS. A scoring system using mPLNs > 3, LVI, and non-SqCC could stratify risk groups of recurrence in surgically resected early-stage cervix cancer with high-risk factors.

Predictive value of preoperative serum squamous cell carcinoma antigen (SCC–Ag) level on tumor recurrence in cervical squamous cell carcinoma patients treated with radical surgery: A single-institution study

“…Pathologic findings including positive resection margin, parametrial involvement, and lymph node metastasis are considered as high-risk factors for recurrence [28], and patients with these pathological features are believed to benefit from additional radiotherapy after radical hysterectomy [29,30]. Our results confirmed that the PFS and OS in patients with high-risk factors were significantly poorer than those without.…”

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

“…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.…”

“…Here, our investigation corroborated these findings, investigating the role of pathological positive nodes in a larger group of patients. Similarly, Kwon et al evaluated a group of 249 cervical cancer patients treated in 13 Korean institutions 14. They observed that the presence of multiple positive nodes (≥4) was an independent predictor for disease-free survival 14.…”

UGT1A1 polymorphism has a prognostic effect in patients with stage IB or II uterine cervical cancer and one or no metastatic pelvic nodes receiving irinotecan chemotherapy

“…It has been reported that the number of metastatic pelvic lymph nodes (≤3 vs. >3) is a signi cant prognostic factor in patients treated with radical surgery followed by postoperative CCRT. Further, no signi cant survival difference is observed between patients without metastasis and those with 1-3 metastatic lymph nodes [20]. Park and Bae reported that the 5year OS rates for patients with stage IB-IIA cervical cancer and 0, 1, and ≥2 positive metastatic lymph nodes were 91, 80, and 47%, respectively (P = 0.006) [21].…”