The prognostic significance of number of positive nodes in cervical carcinoma stages IB, IIA, and IIB

Abstract

Radical hysterectomy and bilateral pelvic lymphadenectomy were done on 875 patients diagnosed with cervical carcinoma Stages IB (484 patients), IIA (96 patients), and IIB (295 patients). The number of positive nodes was 0 in 620 patients (N0), one in 98 patients (N1), two to three in 80 patients (N2), four to 18 in 45 patients (N4), and unresectable in 32 patients. Cumulative 5-year survival rates were 89%, 81%, 63%, 41%, and 23%, respectively. Significant survival reduction rates (P less than 0.05) from N0 to N1 were insignificant in Stage IB patients (92% versus 91%), in those patients without parametrial invasion (92% versus 90%), and in those with parametrial invasion (76% versus 72%). Survival reduction rates (P less than 0.01) from N1 to N2 resulted from a reduction in IB patients without parametrial invasion (100%-71%, P less than 0.01). Survival reduction rates (P less than 0.05) from N2 to N4 resulted from a reduction in Stage IIB patients with parametrial invasion (60%-29%, P less than 0.05). These figures suggest that the number of positive nodes is a more indicative prognostic factor than the existence of nodal metastasis, and that the 5-year survival rates of those patients with one positive node can be improved up to the level of those without nodal metastasis.

Prognostic significance of positive lymph node number in early cervical cancer

“…Regarding LN involvement, there is a positive association between the number of positive LNs and patient prognosis (13,14). The 5-year OS rates for patients with 0, 1 and ≥2 positive pelvic nodes were reported to be 89, 83 and 58%, respectively (P=0.007).…”

“…In cases where there is only 1 positive node, no adverse effect on patient survival has been observed, according to certain authors (16,17). Inoue and Morita (14) reported on the effect of the number of positive LNs on stage IB-IIB cervical cancer. The 5-year OS rates for patients with 0, 1, 2-3 and ≥4 positive nodes were 89, 81, 41 and 23%, respectively.…”

Improvement of Clinical Staging in Cervical Cancer with Serum Squamous Cell Carcinoma Antigen and CA 125 Determinations

“…This noninvasive approach leads to misclassification (mostly understaging) in a considerable number of cases (10-25%), possibly resulting in suboptimal care [2][3][4], Patients with positive lymph nodes and/or clear lymph or blood vessel invasion comprise most of the misclassified cases. Most of these patients need adju vant radiation treatment leading to a higher incidence of severe complications.…”

“…Especially, tumor spread be yond the small pelvis or lymph and blood vessel invasion cannot be detected with this type of staging. When clinical staging was compared with surgical staging, inaccuracies (mostly understaging) were found in 10-25% of patients with clinical stage IB or IIA [2][3][4]. Several authors have demonstrated reduced survival in patients with lymph node metastases and lymph or blood vessel invasion [5,6], It seems useful to develop new strategies to define subgroups of patients in order to further individualize treatment.…”

Comparison of DWI and PET/CT in evaluation of lymph node metastasis in uterine cancer

“…Prognosis depends on pathological stage, tumor grade and histology, and the extent of lymph node (LN) metastasis [2][3][4][5][6][7] . The latter is an important prognostic factor, and the survival rates of patients with nodal metastases are significantly lower than those of patients without such metastases [2][3][4][5][6][7] .…”