Pretreatment Lymph Node Metastasis as a Prognostic Significance in Cervical Cancer: Comparison between Disease Status

Abstract

PurposeLymph node metastasis (LNM) is the most significant prognostic factor in cervical cancer that was recently incorporated into the International Federation of Gynecology and Obstetrics (FIGO) staging system. This study was performed to evaluate whether the prognostic significance of LNM differs according to disease status.Materials and MethodsPatients with FIGO stage IB or higher cervical cancer who had pretreatment computed tomography and/or magnetic resonance imaging studies as well as long-term follow-up were enrolled in this retrospective study. The hazard ratio (HR) of Cox regression was used to determine the prognostic significance of LNM. The HRs were compared between the different tumor groups (based on stage, histology, tumor size, primary treatment, age, parametrium involvement, and lymphovascular space invasion).ResultsA total of 970 patients treated between January 1999 and December 2007 were included. The pretreatment LNM had prognostic significance in patients with stage IB1/IIA (HR for progression-free survival 2.10, p=0.001; HR for overall survival 1.99, p=0.005). However, the significance gradually decreased or disappeared with advancing stages. Similarly, the prognostic significance of the pretreatment LNM decreased with advancing disease status, including old age, parametrial involvement or lymphovascular space involvement. In contrast, the tumor size was associated with the prognostic significance of LNM with advancing status. The significance of the clinical LNM did not reflect the significance of the clinical stage. In contrast, the tumor size, parametrial involvement, and significance of the pathologic LNM reflected the clinical stage.ConclusionIn patients with cervical cancer, pretreatment LNM on imaging has different clinical significance depending on the tumor status.

What MRI-based tumor size measurement is best for predicting long-term survival in uterine cervical cancer?

“…In the present study, large tumor size was associated with histopathologically verified parametrial infiltration and lymph node metastasis in surgically treated patients, as well as with positive corresponding MRI findings guiding stage assignment in 2018 FIGO staging system [ 2 ]. This is in line with prior studies reporting associations between large tumor size (both histopathological and MRI-measured) and pathologically enlarged lymph nodes on MRI [ 31 ], as well as with histologically verified lymph node metastases or parametrial infiltration [ 11 – 13 ].…”

Risk Factor Assessment of Lymph Node Metastasis in Patients With FIGO Stage IB1 Cervical Cancer

“…CC is a common gynaecologic malignant tumour for which postoperative recurrence and metastasis are the main causes of death ( 15 , 16 ). Patients with early-stage CC always have a better prognosis after surgery ( 2 ) but worse prognosis when proven to be metastatic.…”

A Novel Four-Gene Prognostic Signature as a Risk Biomarker in Cervical Cancer

“…Although all studies developed a prediction tool for CC prognosis based on completely different genes, our research paid more attention to the integration of the four-gene prognostic signature and lymph node status. The recent change to FIGO staging of CC cases reflects the importance of LNM status, and several reports have demonstrated that positive pathologic LNM is more strongly associated with the survival rate than other risk factors such as age, histology, and clinical stage [ 16 , 17 ], although LNM status alone may not predict CC prognosis. In the present study, we demonstrated that both the four-gene signature and LNM status had prognostic value for CC, and we developed a nomogram that integrated the four-gene prognostic signature and LNM status to accurately predict the 1- and 3-year OS rates of patients with CC.…”