Lymph node ratio may predict the benefit of postoperative radiotherapy in node-positive cervical cancer
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Juan Zhou1,*, Qiong-Hua Chen1,*, San-Gang Wu2,*, Zhen-Yu He3, Jia-Yuan Sun3, Feng-Yan Li3, Huan-Xin Lin3, Ke-Li You4
1Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
2Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
3Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People’s Republic of China
4Department of Gynecology, GuangDong General Hospital, Guangzhou, People’s Republic of China
*These authors contributed equally to this work
Ke-Li You, email: email@example.com
Keywords: cervical cancer, lymph node ratio, postoperative radiotherapy, survival, SEER
Received: November 28, 2015 Accepted: March 28, 2016 Published: April 18, 2016
The standard treatment for node-positive cervical cancer after radical hysterectomy is pelvic radiotherapy and concurrent chemotherapy. Given the potential toxicity of postoperative radiotherapy, we used the lymph node ratio (LNR) to assess the benefit of postoperative radiotherapy in lymph node-positive cervical cancer patients. Data from the Surveillance Epidemiology and End Results database (1988–2010) were analyzed using Kaplan–Meier and Cox regression proportional hazard analysis. A total of 2,269 eligible patients were identified (median follow-up, 78.0 months); 1,863 (82.1%) patients received postoperative radiotherapy. In both univariate and multivariate analysis multivariate analysis, a higher LNR was significantly associated with a poorer outcome. A LNR > 0.16 was associated with poorer cervical cancer-related survival (CCSS) (hazard Ratio [HR] 1.376, confidence interval [CI] 1.082–1.750; P < 0.001) and overall survival (OS) (HR 1.287, CI 1.056–1.569; P = 0.012). Postoperative radiotherapy was only associated with survival benefits in patients with a LNR > 0.16 (CCSS, P < 0.001; OS, P < 0.001) and not in patients with a LNR ≤ 0.16 (CCSS, P = 0.620; OS, P = 0.167); these trends were not affected by number of removed lymph nodes. A higher LNR is associated with a poorer survival in lymph node-positive cervical cancer. The survival benefits of postoperative radiotherapy appear to be limited to patients with a LNR > 0.16.
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