Incorporation of the number of positive lymph nodes leads to better prognostic discrimination of node-positive early stage cervical cancer
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Juan Zhou1,*, San-Gang Wu2,*, Jia-Yuan Sun3,*, Xu-Lin Liao4, Feng-Yan Li3, Huan-Xin Lin3, Li-Chao Yang5, Zhen-Yu He3
1Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People’s Republic of China
2Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People’s Republic of China
3Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People’s Republic of China
4Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Medical College, Xiamen University, Xiamen 361005, People’s Republic of China
5Faculty of Basic Medicine, Medical College, Xiamen University, Xiamen 361005, People’s Republic of China
*These authors contributed equally to this work
Li-Chao Yang, email: firstname.lastname@example.org
Zhen-Yu He, email: email@example.com
Keywords: cervical cancer, positive lymph nodes, TNM, tumor histology, survival
Received: November 07, 2016 Accepted: January 27, 2017 Published: February 09, 2017
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.
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