Lymph node metastasis as a prognostic factor in patients with cervical cancer

Abstract

Objectives: To elucidate the prognostic significance of the number and level of the involvement of lymph node metastases(LNM) in patients with early cervix cancer. Materials and Methods: Radical hysterectomy and bilateral pelvic lymphadenectomy were done on 366 patients diagnosed with cervical carcinoma stages ⅠB and ⅡA from june 1985 to June 1994 at Chonnam National University Hospital, Kwangju, Korea. Survival analysis was performed using the Kaplan-Meier estimator. Results: The 5 year survival rate in 296 patients without LNM was 95% versus 78% in 70 patients with LNM(p＜0.01). In 56 patients (80%) with single LNM, the 5-year survival rate was 85% versus 50% in 14 patients (20%) with multiple LNM (p＜0.01). The 5-year survival rate in the 7 patients (10%) with extrapelvic LNM (in the common iliac or paraaortic nodes) was 20%. The 5-year survival rate of the 63 patients (90%) with LNM below the level of the common iliac nodes was 84.6%. The difference was statistically significant (p＜0.01). There was no involvement of the common iliac or paraaortic lymph nodes without pelvic node involvement. Conclusions: These figures suggest that the number and site of positive nodes are more important prognostic factor than the existence of nodal metastasis. Although we need a randomized prospective study, it might be expected that the 5-year survival rates of those patients with one positive pelvic node can be improved up to the level of those without nodal metastasis without postoperative adjuvant radiation and/or chemotherapy.