Combining the negative lymph nodes count with the ratio of positive and removed lymph nodes can better predict the postoperative survival in cervical cancer patients

Chen, Ying; Zhang, Lei; Tian, Jing; Ren, Xiubao; Qin, Hao

doi:10.1186/1475-2867-13-6

Cited by 44 publications

(38 citation statements)

References 26 publications

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“…[13–15] Polterauer et al reported on a series of 88 consecutive node-positive patients and found that patients with a LNR>10% had a worse disease-free (HR=2.2, 95% CI 1.1–4.7, p=0.01) and overall survival (HR=2.2, 95% CI 1.0–4.8, p=0.05) compared to those patients with a LNR ≤ 10%. However, this series included all node-positive patients with locally advanced cervical cancer from stage IB1 to IVA treated with primary chemoradiation.…”

Section: Discussionmentioning

confidence: 99%

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Significance of lymph node ratio in defining risk category in node-positive early stage cervical cancer

Fleming

Frumovitz

Schmeler

et al. 2015

Gynecologic Oncology

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Objective The ratio of positive to negative lymph nodes, or lymph node ratio (LNR), is an important prognostic factor in several solid tumors. The objective of this study was to determine if LNR can be used to define a high-risk category of patients with node-positive early stage cervical cancer. Methods We performed a retrospective review of patients diagnosed with node-positive stage I or II cervical cancer who underwent radical hysterectomy and pelvic +/− para-aortic lymphadenectomy at MD Anderson from January 1990 through December 2011. Univariate and multivariate analysis was used to identify prognostic factors for progression-free (PFS) and overall survival (OS). Results Ninety-five patients met inclusion criteria and were included in the analysis. Median total nodes removed were 19 (range 1–58), and median number of positive nodes was 1 (range 1–12). Fifty-eight patients (61%) received radiation with concurrent cisplatin and 27 patients (28%) received radiotherapy alone. Twenty-one (22%) patients recurred. On multivariate analysis, a LNR > 6.6% was associated with a worse PFS (HR=2.97, 95% CI 1.26–7.02, p=0.01), and a LNR > 7.6% with a worse OS (HR=3.96, 95% CI 1.31–11.98, p=0.01). On multivariate analysis, positive margins were associated with worse PFS (p=0.001) and OS (p=0.002), and adjuvant radiotherapy (p=0.01) with improved OS. Conclusions LNR appears to be a useful tool to identify patients with worse prognosis in node-positive early stage cervical cancer. LNR may be used in addition to pathologic risk factors to tailor adjuvant treatment in this population.

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Section: Discussionmentioning

confidence: 99%

“…[11–12] A significant correlation between LNR and survival has also been seen in cervical cancer in single-institution retrospective studies, however, across all stage distributions and in patients receiving neoadjuvant chemotherapy prior to surgery. [13–15]…”

Section: Introductionmentioning

confidence: 99%

Significance of lymph node ratio in defining risk category in node-positive early stage cervical cancer

Fleming

Frumovitz

Schmeler

et al. 2015

Gynecologic Oncology

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“…It's necessary to bring NLN count into the system of prognosis prediction in breast cancer. Many researchers have suggested that NLN count is closely related to the prognosis in gastric cancer (11), colon cancer (12), esophageal cancer (13), and cervical cancer (14). However, few data has been published to elucidate the importance of NLN count in breast cancer prognosis.…”

Section: Original Articlementioning

confidence: 99%

The value of positive lymph nodes ratio combined with negative lymph node count in prediction of breast cancer survival

Yang

Long

et al. 2017

J. Thorac. Dis.

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Background: Positive lymph node ratio (LNR), defined as ratio of positive lymph nodes to all lymph nodes removed, is a powerful prognostic factor in invasive breast cancer. Here we focused on the impact of negative lymph node (NLN) count on the prediction of value of LNR in breast cancer survival.Methods: Of 929 invasive breast cancer patients were enrolled in our retrospective study. We use KaplanMeier to calculate the 5-year overall survival (OS) according to different clinicopathologic parameters. The prediction value of NLN count and LNR in OS was examined.Results: The optimal cutoff of NLN count was designated as 9. Five-year OS was 77.0% and 95.0% Conclusions: High NLN count is associated with improved survival in invasive breast cancer patients.Combining NLN count with LNR could be considered as an alternative to LNR alone in prediction of postoperative breast cancer survival.

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“…While the node-positive patients with RC are heterogeneous and the prognosis of these patients cannot be stratified by the node-stage only [3, 4]. Therefore, the concept of negative lymph node (NLN) counts has attracted attention recently as a prognostic indicator in various cancers, including breast [5], cervical [6], and esophagus [7]. It has been reported that the number of NLNs was an independent prognostic factor for patients with colon cancer [8].…”

Section: Introductionmentioning

confidence: 99%

Negative lymph node count is an independent prognostic factor for patients with rectal cancer who received preoperative radiotherapy

Hao

et al. 2017

BMC Cancer

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BackgroundNegative lymph node (NLN) count has been reported to provide more accurate prognostic information than the N stage alone in patients with rectal cancer (RC). Since preoperative radiotherapy (Pre-RT) can significantly affect the LN status, it is unclear whether NLN count still has prognostic value count on survival of patients with RC who received Pre-RT.MethodsIn this study, clinicopathological characteristics, number of positive LNs and survival time were collected from Surveillance, Epidemiology, and End Results Program (SEER)-registered RC patients. Univariate and multivariate Cox proportional hazards models were used to assess the risk factors for survival.ResultsX-tile plots identified 9 (P < 0.001) as the optimal cutoff NLN value to divide the patients into high and low risk subsets in terms of cause specific survival (CSS). NLN count was validated as independently prognostic factor in univariate and multivariate analysis (P < 0.001). Subgroup analysis showed that NLN count was an independently prognostic factor for patients with stage ypII (P = 0.002) and ypIII (P < 0.001).ConclusionsOur results firmly demonstrated that NLN count provides accurate prognostic information for RC patients with Pre-RT.

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Combining the negative lymph nodes count with the ratio of positive and removed lymph nodes can better predict the postoperative survival in cervical cancer patients

Cited by 44 publications

References 26 publications

Significance of lymph node ratio in defining risk category in node-positive early stage cervical cancer

Significance of lymph node ratio in defining risk category in node-positive early stage cervical cancer

The value of positive lymph nodes ratio combined with negative lymph node count in prediction of breast cancer survival

Negative lymph node count is an independent prognostic factor for patients with rectal cancer who received preoperative radiotherapy

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