The prognostic value of the number of positive lymph nodes and the lymph node ratio in early‐stage cervical cancer

Abstract

Introduction To establish the impact of the number of lymph node metastases (nLNM) and the lymph node ratio (LNR) on survival in patients with early‐stage cervical cancer after surgery. Material and methods In this nationwide historical cohort study, all women diagnosed between 1995 and 2020 with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA2–IIA1 cervical cancer and nodal metastases after radical hysterectomy and pelvic lymphadenectomy from the Netherlands Cancer Registry were selected. Optimal cut‐offs for prognostic stratification by nLNM and LNR were calculated to categorize patients into low‐risk or high‐risk groups. Kaplan–Meier overall survival analysis and flexible parametric relative survival analysis were used to determine the impact of nLNM and LNR on survival. Missing data were imputed. Results The optimal cut‐off point was ≥4 for nLNM and ≥0.177 for LNR. Of the 593 women included, 500 and 501 (both 84%) were categorized into the low‐risk and 93 and 92 (both 16%) into the high‐risk groups for nLNM and LNR, respectively. Both high‐risk groups had a worse 5‐year overall survival (p < 0.001) compared with the low‐risk groups. Being classified into the high‐risk groups is an independent risk factor for relative survival, with excess hazard ratios of 2.4 (95% confidence interval 1.6–3.5) for nLNM and 2.5 (95% confidence interval 1.7–3.8) for LNR. Conclusions Presenting a patient's nodal status postoperatively by the number of positive nodes, or by the nodal ratio, can support further risk stratification regarding survival in the case of node‐positive early‐stage cervical cancer.

A Scoring System to Select the Candidates for Adjuvant Chemotherapy Alone in High-Risk Early-Stage Cervical Cancer Patients With Pelvic Lymph Node Metastases After Surgery

“…A few of the previous studies have explored the prognostic significance of the LNR in cervical cancer patients with LN metastases,18–20,22,23 seldom of which has further investigated the role of LNR in aiding in the adjuvant treatment decision making. We chose LNR to represent the LN status in this study due to the most excellent prediction ability of this index compared with other LN indices 18,22,24. The LNR, covering the information on the number of positive LNs and retrieved LNs (RLNs), was genetically insufficient to differentiate the survival for patients with different positive LNs and RLNs but shared the identical LNR, it is, whether patients with 1 positive LN of 1 retrieved LN performed equally in survival when compared with the patients with 10 positive LNs of 10 retrieved LNs.…”

“…Tumor size (≤2.0 cm, 2.1 to 4.0 cm, and ≥4.1 cm) was categorized according to previous studies 9,11,13,18 and the tumor size of surgical patients was recorded according to pathologic findings. We used X-tile software (version 3.6.1; Yale University, New Haven, Connecticut, USA) to divided age into 3 subgroups (below 50, 50 to 65, and above 65) due to the inconsistence of this category in previous studies 9,11–13,18. Noteworthy, we chose lymph node ratio (LNR), the most representative LN status, to proceed with the following analysis 18–20.…”

“…We used X-tile software (version 3.6.1; Yale University, New Haven, Connecticut, USA) to divided age into 3 subgroups (below 50, 50 to 65, and above 65) due to the inconsistence of this category in previous studies. 9,[11][12][13]18 Noteworthy, we chose lymph node ratio (LNR), the most representative LN status, to proceed with the following analysis. [18][19][20] Besides, the LNR in our study was supposed to be more predictive than in other studies given that only patients with adequate lymphadenectomy were included in this study.…”

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

“…LNR has recently become a relatively new prognostic factor to be included in the study. It is a comprehensive factor which refers to the ratio between the number of positive lymph nodes and the total number of lymph nodes removed after surgery [19]. It is related to both metastatic lymph node burden and whether lymph node resection is complete.…”

Predictive value of the number of metastatic lymph nodes and lymph node ratio on the prognosis of patients with FIGO 2018 stage IIICp cervical cancer: a multi-center retrospective study

“…Tsai et al, 1999;Olthof et al, 2022). While cut-off values for nMLN ranging from ≥ 2 to > 5 have been reported(Inoue and Morita 1990;Sakuragi et al, 1999;Tsai et al, 1999;Pedone et al, 2020;Olthof et al, 2022), the optimal cut-off value is still being explored.…”