Abstract
BackgroundPelvic lymph nodes metastasis is an important prognostic factor for patients with cervical carcinoma. However, the relationships between the number of positive nodes, site of metastases nodes, adjuvant therapy and the prognosis is controversial. The purpose of this study was to investigate the influence of positive lymph nodes on the prognosis of Chinese women with stage IB1-IIB cervical carcinoma.Patients and methodsBetween January 1992 and December 1997, 398 women with International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IIB cervical carcinoma underwent radical surgery in Cancer Hospital, Fudan University. Of these sixty-six patients (16.6%) who were histologically confirmed to have positive pelvic lymph nodes were analyzed retrospectively. The survival was estimated using Kaplan-Meier method. The differences in survival were compared with Log-rank test. Multivariate analyses were performed with the Cox proportional hazard model.ResultsThe 5-year survival of the patients with pelvic lymph nodes metastases was 40.7%. Cox proportional hazard model analysis showed that cellular differentiation, the number of positive nodes and adjuvant therapy to be the independent prognostic factors (P < 0.05). The 5-year survival of patients with one positive node was higher than that of those with two or more positive nodes (56.5% vs. 36.4%, P < 0.05). The distant metastasis rate in the former group (5.9%) was lower than the latter's (32.7%) (P = 0.05). However, there was no significant difference of pelvic recurrence between the two groups (P > 0.05). The number of positive nodes positively correlated with the level of positive nodes (P < 0.01). The 5-year survival of the patients who had no adjuvant therapy (12.6%) was much lower than that (53.7%) of those with adjuvant therapy (P < 0.05). However, there was no obvious difference between adjuvant radiotherapy, chemotherapy and chemo-radiotherapy (P > 0.05).ConclusionsThe prognosis of patients with stage IB1-IIB node-positive cervical carcinoma who underwent radical surgery alone was very poor. Adjuvant therapy increases the survival rate, decreases the pelvic recurrence and distant metastasis.
Highlights
Pelvic lymph nodes metastasis is an important prognostic factor for patients with cervical carcinoma
This study investigated the factors that could predict the prognosis of the patients with stage IB1-IIB node-positive cervical carcinoma
The 5-year survival of patients with one positive node (56.5%) was higher than that (36.4%) of those with two or more positive nodes (P < 0.05)
Summary
Pelvic lymph nodes metastasis is an important prognostic factor for patients with cervical carcinoma. In most of the studies the presence of pelvic lymph node metastases has been associated with increased pelvic recurrence and distance metastases, and a decrease in overall survival [2,3,4,5,6,7]. Many questions such as the relationship between the numbers, the site of positive nodes, the modality of postoperative multidisciplinary therapy and the prognosis is not yet clear. This study investigated the factors that could predict the prognosis of the patients with stage IB1-IIB node-positive cervical carcinoma
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