Incorporation of the number of positive lymph nodes leads to better prognostic discrimination of node-positive early stage cervical cancer

Juan Zhou, San-Gang Wu, Jia-Yuan Sun, Xu-Lin Liao, Feng-Yan Li, Huan-Xin Lin, Li-Chao Yang, Zhen-Yu He, Juan Zhou, San-Gang Wu, Jia-Yuan Sun, Xu-Lin Liao, Feng-Yan Li, Huan-Xin Lin, Li-Chao Yang, Zhen-Yu He

Abstract

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.

Keywords: TNM; cervical cancer; positive lymph nodes; survival; tumor histology.

Conflict of interest statement

CONFLICTS OF INTEREST

The authors declare that there are no conflicts of interest.

Figures

Figure 1. Cause-specific survival
Figure 1. Cause-specific survival
(A) and overall survival (B) for patients with cervical cancer stratified by the number of positive lymph nodes.
Figure 2. Cause-specific survival
Figure 2. Cause-specific survival
(A) and overall survival (B) for patients with cervical squamous cell carcinoma using the proposed revised TNM classification system.
Figure 3. Cause-specific survival
Figure 3. Cause-specific survival
(A) and overall survival (B) for patients with cervical adenosquamous carcinoma using the proposed revised TNM classification system.

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