Cancer Res Treat.  2018 Jul;50(3):964-974. 10.4143/crt.2017.346.

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)

• Kwon J
• Eom KY
• Kim YS
• Park W
• Chun M
• Lee J
• Kim YB
• Yoon WS
• Kim JH
• Choi JH
• Chang SK
• Jeong BK
• Lee SH
• Cha J

• KMID: 2417885
• DOI: http://doi.org/10.4143/crt.2017.346

Abstract

PURPOSE
We 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 METHODS
A 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)).
RESULTS
In 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).
CONCLUSION
mPLN > 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.

Keyword

Uterine cervical neoplasms; Adjuvant treatment; Combined modality therapy; Lymphatic metastasis; Scoring system

MeSH Terms

Chemoradiotherapy
Cohort Studies*
Combined Modality Therapy
Disease-Free Survival
Humans
Lymph Nodes*
Lymphatic Metastasis
Multivariate Analysis
Recurrence*
Retrospective Studies
Risk Factors*
Uterine Cervical Neoplasms*

Figure

• 

  Fig. 1. Distant metastasis-free survival (DMFS) and disease-free survival (DFS) curves according to pN stage (A), and number of metastatic pelvic lymph nodes (LNs) (B).

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  Fig. 2. Distant metastasis-free survival (DMFS) (A) and disease-free survival (DFS) (B) curves according to the scoring system.

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  Fig. 3. Nomogram predicting disease-free survival (DFS) (A) and calibration plot (B). SqCC, squamous cell carcinoma.

Reference

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