Abstract
Objective To determine whether the number of removed lymph nodes (RLN) is associated with survival in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB-IIA cervical squamous cell carcinoma (CSCC). Methods We reviewed the medical records of FIGO stage IB-IIA CSCC patients who underwent standardized radical hysterectomy with pelvic lymphadenectomy (RHPL) in our center between 2006 and 2014. The X-tile software was performed to calculate the optimal grouping of cutoff points for RLN. The impact of RLN on progression-free survival (PFS) and overall survival (OS) was analyzed using Cox regression analysis. Results Among 3,127 patients, the mean number of RLN was 22, and positive lymph node (LN) was found in 668 (21.4%) patients. X-tile plots identified “21” and “16” as the optimal cutoff value of RLN to divide the patients into two groups in terms of PFS and OS separately. In all patients, the number of RLN was not associated with PFS (P=0.182) or OS (P=0.193). Moreover, in both LN positive and negative patients, the number of RLN was not associated with either PFS (P=0.212 and P=0.540, respectively) or OS (P=0.173 and P=0.497, respectively). Cox regression analysis showed that the number of RLN was not an independent prognostic factor for PFS or OS. Conclusion If standardized RHPL was performed, the number of RLN was not an independent prognostic factor for survival of patients with FIGO stage IB-IIA CSCC.
Highlights
Despite efficient screening and vaccination [1, 2], cervical cancer continues to be the fourth most prevalent cause of cancer-related death in women worldwide, especially in developing countries [3]
Radical hysterectomy with pelvic lymphadenectomy (RHPL) is the standard surgical treatment for early-stage cervical cancer, in particular, International Federation of Gynecology and Obstetrics (FIGO) 2009 Stage IB-IIA disease [4]
There is no relevant report to describe the possible benefit of a more extensive lymphadenectomy for patients with early-stage Cervical squamous cell carcinoma (CSCC). rough the survival analysis of our patient’s cohort treated with standard RHPL, we investigated whether the number of removed lymph nodes (RLN) is an independent prognostic factor for survival of patients with FIGO stage IB-IIA CSCC
Summary
Despite efficient screening and vaccination [1, 2], cervical cancer continues to be the fourth most prevalent cause of cancer-related death in women worldwide, especially in developing countries [3]. Cervical squamous cell carcinoma (CSCC), the most common pathological type of cervical cancer, accounts for about 80–90% but is less likely to develop lymph node metastasis than adenocarcinoma and adenosquamous cell carcinoma [5]. Most tumors typically spread multidirectionally via the lymphatic system; lymph nodal (LN) status is a strong prognostic factor for survival in patients with cervical cancer [6]. Given the long natural history of LN dissections for tumors, it was our instinct that a more thorough lymphadenectomy should increase the number of removed lymph nodes (RLN), and the more nodes retrieved, the more likelihood of the better survival. For non-small cell lung cancer [8] or bladder cancer [9], previous studies had reported the survival benefits for patients who had undergone the removal of an increased number of LN. For non-small cell lung cancer [8] or bladder cancer [9], previous studies had reported the survival benefits for patients who had undergone the removal of an increased number of LN. ese authors believe that a more extensive lymphadenectomy
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