Should the Number of Metastatic Pelvic Lymph Nodes be Integrated into the 2018 Figo Staging Classification of Early Stage Cervical Cancer?

Luigi Pedone Anchora, Vittoria Carbone, Valerio Gallotta, Francesco Fanfani, Francesco Cosentino, Luigi Carlo Turco, Camilla Fedele, Nicolò Bizzarri, Giovanni Scambia, Gabriella Ferrandina, Luigi Pedone Anchora, Vittoria Carbone, Valerio Gallotta, Francesco Fanfani, Francesco Cosentino, Luigi Carlo Turco, Camilla Fedele, Nicolò Bizzarri, Giovanni Scambia, Gabriella Ferrandina

Abstract

Introduction: Lymph node status has become part of the new staging system for cervical cancer (CC). It has been shown that patients staged as IIIC1 had heterogeneous prognoses and, in some cases, experienced better outcomes than patients with lower stages. We evaluated the impact of the number of metastatic pelvic lymph nodes (MPLNs) among patients with stage IIIC1 cervical cancer.

Methods: Survival analyses were conducted in order to identify the best cut-off prognostic value relative to the number of MPLNs. Disease free survival (DFS) was considered the main outcome.

Results: 541 patients were included in the study. Eighty-nine patients were of stage IIIC1. The best prognostic cut-off value of the number of MPLNs was 2. Patients with >2 MPLNs (n > 2 group) had worse DFS compared with those having <2 (N1-2 group) (5 yr DFS: 54.7% vs 78.1%, p value = 0.006). Multivariate analyses demonstrated that the extent of MPLNs had little impact on DFS and that replacement of IIIC1 staging with N1-2 and n > 2 grouping provided a better, statistically significant model (p value = 0.006).

Discussion: Using a cut-off value of 2, the number of MPLNs could better predict prognostic outcomes within stage IIIC1 cervical cancer and have potential implications for therapeutic decision-making in the treatment of patients with stage IIIC1 CC.

Keywords: FIGO; IIIC; cervical cancer; cut-off; lymph node; number of lymph nodes; number of metastatic lymph nodes; staging system.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of patients in the series. FIGO: International Federation of Gynecology and Obstetrics.
Figure 2
Figure 2
(A) Distribution of the number of metastatic pelvic lymph nodes per patient. (B) Disease free survival according to the cut off value of the number of metastatic pelvic lymph nodes representing the 25th (panel a), 50th (panel b), 75th (panel c) percentiles.
Figure 3
Figure 3
(A) Disease free survival (DFS) in the whole series according to the FIGO 2018 staging system; (B) DFS in the whole series according to the proposed FIGO 2018 staging system. Arrows highlight the DFS curve for stage IIIC1 in panel A, as well as the subgroups N1-2 and n > 2 in panel B.

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