Prognostic analysis of patients with stage IIIC1p cervical cancer treated by surgery

Abstract

Background Cervical cancer (CC) is one of the most common gynecologic malignancies. The prognosis of patients with stage IIIC1p cervical cancer treated by surgery is heterogeneous. Therefore, the aim of this study was to analyze the factors influencing the prognosis of patients with stage IIIC1p cervical cancer treated by surgery. Methods From January 2012 to December 2017,102 patients with cervical cancer who underwent surgical treatment in Department of Gynecology and Tumors, Changzhou Maternal and Child Health Hospital and had pelvic lymph node metastasis confirmed by pathology were analyzed retrospectively. All patients underwent radical hysterectomy with/without oophorectomy with pelvic lymphadenectomy with/without para-aortic lymphadenectomy. Information about the clinical features of patients were collected, including age, surgical method, ovarian status, intraoperative blood loss, perioperative complications, tumor size, pathological type, depth of stromal invasion(DSI), whether lymphatic vascular space was infiltrated, number of pelvic lymph node metastases, location of pelvic lymph node metastases, total number of lymph nodes resected, lymph node ratio(LNR), nature of vaginal margin, whether parametrium was involved, postoperative adjuvant therapy, preoperative neutrophil-lymphocyte ratio (NLR), and prognostic information of patients were followed up. Survival curves for overall survival(OS) and disease-free survival(DFS) were plotted using the Kaplan-Meier method, and the difference between the survival curves was tested using the log-rank test. Univariate and multivariate COX regression models were used to assess the factors associated with overall survival and disease-free survival in patients with IIIC1p cervical cancer. Nomogram plots were constructed to predict OS and DFS, and the predictive accuracy of nomograms was measured by Harrell's C-index and calibration curves. Results A total of 102 patients with stage IIIC1p cervical cancer were included in the study, with a median follow-up time of 63 months (range from 6 to 130 months). The 5-year OS was 64.7% and the 5-year DFS was 62.7%. Multivariate analysis showed that no postoperative adjuvant therapy, LNR > 0.3 and NLR > 3.8 were independent risk factors for OS and DFS in patients with stage IIIC1p cervical cancer. Conclusions Patients with stage IIIC1p cervical cancer have a poor prognosis. Lower OS and DFS were associated with no postoperative adjuvant therapy, LNR > 0.3, and NLR > 3.8.