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

Abstract

Background Cervical cancer (CC) is one of the most common gynaecologic malignancies. The prognosis of stage IIIC1p cervical cancer patients treated by surgery is heterogeneous. Therefore, the aim of this study was to analyse the factors influencing the prognosis in such patients. Methods From January 2012 to December 2017, 102 patients with cervical cancer who underwent surgical treatment in the Department of Gynaecology and Tumours, Changzhou Maternal and Child Health Hospital, and had pelvic lymph node metastasis confirmed by pathology were analysed retrospectively. All patients underwent radical hysterectomy with/without oophorectomy with pelvic lymphadenectomy with/without para-aortic lymphadenectomy. Clinical data was collected including age, surgical method, ovarian status, intraoperative blood loss, perioperative complications, tumour size, pathological type, depth of stromal invasion (DSI), whether the 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. 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 stage IIIC1p cervical cancer. Nomogram plots were constructed to predict OS and DFS, and the predictive accuracy of the 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, and the median follow-up time was 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.

Prognostic analysis of stage IIIC1p cervical cancer patients

“…Fan et al. found that no postoperative adjuvant therapy was an independent risk factor for poor OS and DFS in patients with stage IIIC1p cervical cancer ( 9 ). Simultaneous dual-platinum-based chemotherapy and pelvic radiation therapy could be a potential approach to enhance results in these patients ( 18 ).…”

“…Fan et al. found that NLR>3.8 were independent risk factors for OS and DFS in patients with stage IIIC1p cervical cancer ( 9 ). Increased MLR indicated an increased in monocytes and a decrease in lymphocytes.…”

“…and Li et al. both analyzed the total number of lymph nodes resected, number of pelvic LNM, location of pelvic LNM, and ratio of LNM in patients with stage IIIC1p cervical cancer ( 9 , 10 ). They identified the ratio of LNM >0.3 or the ratio of LNM ≥0.08 as an independent risk factor for OS and DFS in patients with stage IIIC1p cervical cancer, respectively, and conducted a more detailed stratified analysis of the ratio of LNM in the Li et al.…”

“…The ratio of LNM has been acknowledged as a distinct prognostic indicator of different types of cancers ( 26 – 29 ). Some researchers have suggested that a higher ratio of LNM, is indicative of a higher intranodal tumor burden and may increase the likelihood of tumor cell spillage during lymphadenectomy, contributing to poorer outcomes ( 9 ). This hypothesis was consistent with our results.…”

“…Several studies have suggested that parameters such as the number of LNM, ratio of LNM (proportion of positive to total lymph nodes removed), and number of LNM sites are correlated with OS ( 9 – 11 ). Furthermore, the prognosis of patients with IIIC1p was found to be associated with pathological type ( 12 , 13 ), pT2b ( 12 ), and neutrophil-to-lymphocyte ratio (NLR) > 3.8 ( 9 ). Nevertheless, elucidating which factors are more effective in assessing the outlook of individuals with IIIC1p cervical cancer remains unresolved.…”