Abstract
To determine the prognostic value of the number of positive lymph nodes (LNs) in cervical cancer and further stratify patients with positive LNs into multiple risk groups based on analysis of Surveillance Epidemiology and End Results (SEER) program. Patients with cervical cancer who undergo hysterectomy and had pathologically-confirmed positive LNs after lymphadenectomy were identified using the SEER database (1988-2012). Kaplan–Meier survival methods and Cox proportional hazards regression were performed. We included 2,222 patients with the median number of removed LNs and positive LNs was 22 and 2, respectively. Multivariable Cox analysis showed patients with > 2 positive LNs had poorer cause-specific survival (CSS) (hazard ratio [HR] 1.631, 95% confidence interval [CI] 1.382–1.926, P < 0.001) and overall survival (OS) (HR 1.570, 95% CI 1.346–1.832, P < 0.001) than patients with 1–2 positive LNs. Five-year CSS and OS were 78.9% vs. 65.5% (P < 0.001) and 76.7% vs. 62.7% (P < 0.001) for 1–2 positive LNs and > 2 positive LNs, respectively. The number of positive LNs had prognostic value in cervical squamous cell carcinoma or adenosquamous carcinoma, but not in cervical adenocarcinoma. The number of positive LNs is an independent risk factor for CSS and OS in cervical cancer. This new category might be helpful in better prognostic discrimination of node-positive early stage cervical cancer after hysterectomy.
Highlights
Uterine cervical cancer is common worldwide [1]
We used the Surveillance Epidemiology and End Results (SEER) database to evaluate the prognostic value of the number of positive lymph nodes (LNs) in node-positive early stage cervical cancer after hysterectomy
Our results showed that a higher number of positive LNs was associated with adverse survival outcomes
Summary
Uterine cervical cancer is common worldwide [1]. According to the National Cancer Institute, there were approximately 12,990 new cases diagnosed and 4,120 deaths due to cervical cancer in 2016 [2]. The survival rates for patients with early stage cervical cancer treated with radical hysterectomy in combination with pelvic and/or para-aortic lymphadenectomy were comparable to patients who receive concurrent chemoradiotherapy (CCRT) [3, 4]. Hysterectomy combined with lymphadenectomy enables clinicians to accurately assess tumor status and guide postoperative adjuvant therapy. Lymphadenectomy allows the lymph node status to be accurately assessed. Previous studies have demonstrated that lymph node status was the main factor that influences survival outcomes in cervical cancer [6,7,8,9]. The number of positive LNs is assessed during lymph node staging in a variety of malignant tumors, including breast cancer, esophageal cancer, colorectal cancer, and gastric cancer [10]. Lymph node status is not included in the International Federation of Gynecology and Obstetrics (FIGO) staging system [11]
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