Impact of the Ratio of Metastatic to Examined Lymph Nodes on the Survival of Early-Stage Cervical Cancer Patients

Abstract

Background: The aim of the study was to determine the impact of the ratio of metastatic to examined lymph nodes (LN) on the survival of early-stage cervical cancer patients. Methods: A retrospective review was performed of all patients undergoing primary radical hysterectomy and pelvicparaaortic lymphadenectomy for stage I–II cervical cancer at the Ankara Oncology Hospital from 1995 to 2000. Survival was determined by Kaplan-Meier method and differences were assessed by log-rank test. Results: A total of 2,085 LN were examined. Nodal metastasis was found in 22.1% of the patients. Patients with zero involved LN had a 5-year survival of 89.19%, while patients with 1 positive LN and > 1 positive LNs had a 5-year survival of 100 and 76.92%, respectively. The difference in survival among these three groups was not statistically significant. The 5-year survival rates according to the metastatic/examined LN ratio (LNR) were 75, 90, and 89.19% in the groups of patients with LNR >10, 1–10, and 0%, respectively. The difference in survival among these three groups was not statistically significant. Conclusions: This factor might be helpful for a better prognostic discrimination of patients with metastatic LN. The stratification of node-positive cervical cancer for prognostic and treatment purposes warrants further investigation.

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

“…However, Metindir et al . [10] and Polterauer et al . [11] drew diametrically opposite conclusions on the impact of RPL on the prognosis of cervical cancer patients.…”

“…In contrast, Metindir et al . [10] reported that RPL did not reach statistical significance in their study, though this was likely due to the small number of patients with positive nodes (18 cases) and too small to have statistical power cutoffs in analysis. Because the lymph nodes examined in cervical cancer include positive and negative lymph nodes that are collected from patients simultaneously, the number of negative lymph nodes (NLNs) should be associated with the RPL and prognosis of cervical cancer after RHPL.…”

“…The ratio of positive and removed lymph nodes (RPL) may obviate possible confounding effects and be a more accurate representation of the status of pelvic lymph node metastasis [10]. Polterauer et al .…”

Significance of the Absolute Number and Ratio of Metastatic Lymph Nodes in Predicting Postoperative Survival for the International Federation of Gynecology and Obstetrics Stage IA2 to IIA Cervical Cancer

“…However, they suggested that the RPL might be helpful in a better prognostic discrimination of patients with MLNs, and larger studies would have to be done to confirm that. 12 We thought that the stratification of node metastasis cervical cancer for prognostic and treatment purposes should warrant further investigation. In this study, we evaluated the prognostic significance of the RPL and MLN count in International Federation of Gynecology and Obstetrics (FIGO) stage IA2 to IIA cervical cancer with lymph node metastasis after RPHL.…”

Does Lymphatic Involvement Impact Survival of Early Stage Cervical Cancer Patients?

“…Nevertheless, in daily routine nodal status is already important not only for the prognosis also for therapeutical decisions. For this reason, Metindir and Bilir [2] performed their evaluation of 92 patients with FIGO I and II carcinoma of the cervix treated by Type II-III radical hysterectomy and bilateral pelvic and periaortic lymphadenectomy in a single institution. Patients with paraaortic lymph node involvement were excluded.…”