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The Prognostic Impact of the Number of Metastatic Lymph Nodes and a New Prognostic Scoring System for Recurrence in Early-Stage Cervical Cancer with High Risk Factors: A Multicenter Cohort Study (KROG 15-04)
- The Prognostic Impact of the Number of Metastatic Lymph Nodes and a New Prognostic Scoring System for Recurrence in Early-Stage Cervical Cancer with High Risk Factors: A Multicenter Cohort Study (KROG 15-04)
- Chang, Sei Kyung; Jeong, Bae Kwon; Lee, Seok Ho; Cha, Jihye; Kwon, Jeanny; Eom, Keun-Young; Kim, Young Seok; Park, Won; Chun, Mison; Lee, Jihae; Kim, Yong Bae; Yoon, Won Sup; Kim, Jin Hee; Choi, Jin Hwa
- Ewha Authors
- SCOPUS Author ID
- Issue Date
- Journal Title
- CANCER RESEARCH AND TREATMENT
- 1598-2998; 2005-9256
- vol. 50, no. 3, pp. 964 - 974
- Uterine cervical neoplasms; Combined modality therapy; Lymphatic metastasis; Scoring system; Adjuvant treatment
- KOREAN CANCER ASSOCIATION
- SCIE; SCOPUS; KCI
- Purpose We aimed to assess prognostic value of metastatic pelvic lymph node (mPLN) in early-stage cervical cancer treated with radical surgery followed by postoperative chemoradiotherapy. Also, we sought to define a high-risk group using prognosticators for recurrence. Materials and Methods A multicenter retrospective study was conducted using the data from 13 Korean institutions from 2000 to 2010. A total of 249 IB-IIA patients with high-risk factors were included. We evaluated distant metastasis-free survival (DMFS) and disease-free survival (DFS) in relation to clinicopathologic factors including pN stage, number of mPLN, lymph node (LN) ratio (number of positive LN/number of harvested LN), and log odds of mPLNs (log(number of positive LN+0.5/number of negative LN+0.5)). Results In univariate analysis, histology (squamous cell carcinoma [SqCC] vs. others), lymphovascular invasion (LVI), number of mPLNs (<= 3 vs. > 3), LN ratio (<= 17% vs. > 17%), and log odds of mPLNs (<= -0.58 vs. > -0.58) were significant prognosticators for DMFS and DFS. Resection margin involvement only affected DFS. No significant survival difference was observed between pN0 patients and patients with 1-3 mPLNs. Multivariate analysis revealed that mPLN > 3, LVI, and non-SqCC were unfavorable index for both DMFS (p < 0.001, p=0.020, and p=0.031, respectively) and DFS (p < 0.001, p=0.017, and p=0.001, respectively). A scoring system using these three factors predicts risk of recurrence with relatively high concordance index (DMFS, 0.69; DFS, 0.71). Conclusion mPLN > 3 in early-stage cervical cancer affects DMFS and DFS. A scoring system using mPLNs > 3, LVI, and non-SqCC could stratify risk groups of recurrence in surgically resected early-stage cervix cancer with high-risk factors.
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