Abstract
BackgroundTo evaluate the impacts of the negative lymph nodes (NLNs) count on the prognostic prediction of the ratio of positive and removed lymph nodes (RPL) in cervical cancer patients after radical hysterectomy and pelvic lymphadenectomy (RHPL).MethodsThe positive and negative lymph node counts were calculated for 609 postoperative cervical cancer patients. The 5-year survival rate (5-YSR) was examined according to clinicopathologic variables. Cox regression was used to identify independent prognostic factors.ResultsThe NLNs count cutoffs were determined to be 10 and 25 with 5-YSR of 62.8% and 80.5%. The RPL of 13 patients who had the NLNs count of 10 or fewer was >20%. Among 242 patients who had 10 < NLNs count ≤ 25, 194 without positive nodes had the 5-YSR of 77.8%, 31 with 0% < RPL ≤ 5% had the 5-YSR of 3.2%, 15 with RPL > 20% had died when follow-up was completed. Among 354 patients who had NLNs count >25, 185 without positive nodes had the 5-YSR of 87.6%, 6 with 0% < RPL ≤ 5% had the 5-YSR of 25%, 15 with 5% < RPL ≤ 20% had the 5-YSR of 4.5%, and 2 with RPL >20% had died when follow-up was completed. Furthermore, stage, histologic grade and RPL were independently correlated with overall survival of cervical cancer patients after RHPL in the multivariate analysis.ConclusionsRPL was an independent prognostic factor. The NLNs count is a key factor for improvement of survival prediction of RPL in cervical cancer.
Highlights
Cervical cancer is the third most common cancer and the fourth leading cause of cancer death in women worldwide, especially in developing countries [1]
The cut point analysis were performed to determine the best cutoffs of the Ratio of positive and removed lymph nodes (RPL) and the Negative lymph node (NLN) count to detect the greatest actuarial survival difference among the resulting subgroups
Results for the relevant cut points and stage subgroups according to the RPL and NLNs count are listed in Tables 2 and 3
Summary
Cervical cancer is the third most common cancer and the fourth leading cause of cancer death in women worldwide, especially in developing countries [1]. Some studies deemed that extensive lymphadenectomy increases survival. Kim et al [6] demonstrated that removal of an increasing number of lymph nodes may be associated with better survival in patients with lymph node metastasis. Kim’s result was inconsistent with the study by Shah et al [7], which revealed that more extensive lymphadenectomy was associated with improved survival in patients without nodal metastasis. Prapaporn et al [8] verified that there was not a significant improvement in DFS associated with removal of an increasing number of nodes regardless of nodal status. To evaluate the impacts of the negative lymph nodes (NLNs) count on the prognostic prediction of the ratio of positive and removed lymph nodes (RPL) in cervical cancer patients after radical hysterectomy and pelvic lymphadenectomy (RHPL)
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