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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).

 Jeanny Kwon  ;  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 
 CANCER RESEARCH AND TREATMENT, Vol.50(3) : 964-974, 2018 
Journal Title
Issue Date
Adult ; Aged ; Carcinoma, Squamous Cell/pathology* ; Carcinoma, Squamous Cell/therapy* ; Chemoradiotherapy, Adjuvant ; Female ; Humans ; Hysterectomy ; Lymph Nodes/pathology* ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Recurrence, Local/pathology* ; Neoplasm Staging ; Pelvis ; Prognosis ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Survival Analysis ; Uterine Cervical Neoplasms/pathology* ; Uterine Cervical Neoplasms/therapy*
Adjuvant treatment ; Combined modality therapy ; Lymphatic metastasis ; Scoring system ; Uterine cervical neoplasms
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.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
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