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).
- Author:
Jeanny KWON
1
;
Keun Young EOM
;
Young Seok KIM
;
Won PARK
;
Mison CHUN
;
Jihae LEE
;
Yong Bae KIM
;
Won Sup YOON
;
Jin Hee KIM
;
Jin Hwa CHOI
;
Sei Kyung CHANG
;
Bae Kwon JEONG
;
Seok Ho LEE
;
Jihye CHA
Author Information
- Publication Type:Multicenter Study ; Original Article
- Keywords: Uterine cervical neoplasms; Adjuvant treatment; Combined modality therapy; Lymphatic metastasis; Scoring system
- MeSH: Chemoradiotherapy; Cohort Studies*; Combined Modality Therapy; Disease-Free Survival; Humans; Lymph Nodes*; Lymphatic Metastasis; Multivariate Analysis; Recurrence*; Retrospective Studies; Risk Factors*; Uterine Cervical Neoplasms*
- From:Cancer Research and Treatment 2018;50(3):964-974
- CountryRepublic of Korea
- Language:English
- 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.
