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

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

doi:10.1097/igc.0b013e3182778bcf

Cited by 37 publications

(40 citation statements)

References 26 publications

(20 reference statements)

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“…An additional subset analysis was performed examining LNR previously published in the literature of ≤ 10% and >10%. [13,14] We did not see a significant association of LNR >10% with PFS (HR 1.20, 95% CI 0.52–2.77, p=NS) or OS (HR 1.17, 95% CI 0.41–3.28, p=NS), even in those patients that had ≥ 10 lymph nodes removed.…”

Section: Resultsmentioning

confidence: 62%

“…It is unclear how treatment with neoadjuvant chemotherapy may have affected their reported LNR and overall results. [14]…”

Section: Discussionmentioning

confidence: 99%

“…This method also takes into account the fact that multiple testing is being done in the search for the cutpoint, so the p-value reported from the method is adjusted for the multiple testing in order to avoid inflating the Type I Error. [16] A subset analysis was performed using previously published lymph node ratio cutoffs in cervical cancer of ≤ 10% and >10% [13,14] and in those patients who had at least 10 lymph nodes removed. P<0.05 was considered statistically significant.…”

Section: Methodsmentioning

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: Resultsmentioning

confidence: 62%

“…It is unclear how treatment with neoadjuvant chemotherapy may have affected their reported LNR and overall results. [14]…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

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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“…Thus, the FIGO guidelines have been used to categorise patients into a high-risk group and an intermediate-risk group according to the pathological risk factors, including positive pelvic lymph nodes, microscopic parametrical invasion, tumour-positive resection margins and deep stromal invasion (Biewenga et al , 2011), that can subsequently affect the decision to perform adjuvant therapy. Among these factors, pelvic lymph node metastases are the most important postoperative risk factor for recurrence or failure to survive, and thus require adjuvant therapy (Kodama et al , 2010; Biewenga et al , 2011; Chen et al , 2013). Unfortunately, gynaecological oncologists could not determine treatment properly because the sentinel lymph node biopsy as a promising technique failed to show sufficiently accuracy to detect micrometastases with a high false negative rate as well as the imaging methods (Altgassen et al , 2008; Selman et al , 2008; Slama et al , 2013).…”

Section: Discussionmentioning

confidence: 99%

TBLR1 is a novel prognostic marker and promotes epithelial–mesenchymal transition in cervical cancer

Wang

Guo

et al. 2014

Br J Cancer

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Background:Invasion and metastasis remain a critical issue in cervical cancer. However, the underlying mechanism of it in cervical cancer remains unclear. The newly discovered protein, TBLR1, plays a crucial role in regulating various key cellular functions.Methods:In this study, western blot, real-time RT–PCR, immunohistochemical staining, 3D morphogenesis Matrigel culture, wound healing and Boyden chamber invasion assays, xenografted tumour model, luciferase assays, and chromatin immunoprecipitation assays were used.Results:The expression of TBLR1 in cervical cancer cell lines and tissues was significantly upregulated at both the RNA and protein levels compared with that in normal cervical cells. Statistical analysis suggested that TBLR1 as an independent prognostic factor was significantly correlated with the clinical stage, survival time and recurrence. Moreover, overexpression of TBLR1 in Hela and Siha cell lines promoted invasion in vitro and in vivo with the increases of the mesenchymal factors vimentin and fibronectin and decreases of the epithelial marker α-catenin. In contrast, RNAi-mediated knockdown of TBLR1 inhibited epithelial–mesenchymal transition in vitro and in vivo. Further study indicated that this might be mediated via the NF-κB and Wnt/β-Catenin signalling pathway, and involve regulation of Snail and Twist.Conclusions:The TBLR1 protein may be a prognostic marker in cervical cancer and play an important role in the invasion and metastasis of human cervical cancer.

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“…Pelvic lymph node metastases act as an important risk factor for recurrence or death in cervical cancer [158,159]. According to the International Federation of Gynaecology and Obstetrics (FIGO) staging system, lymph node metastasis is the strongest prognostic factor for early stage cervical cancer (FIGO stage Ib-IIa) and provides important information for determining the treatment approach.…”

Section: Impact Of Emt In Clinical Treatment Of Cervical Cancermentioning

confidence: 99%

EMT in cervical cancer: Its role in tumour progression and response to therapy

2015

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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

Cited by 37 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

TBLR1 is a novel prognostic marker and promotes epithelial–mesenchymal transition in cervical cancer

EMT in cervical cancer: Its role in tumour progression and response to therapy

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