KMID : 0939920180500030964
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´ëÇѾÏÇÐȸÁö 2018 Volume.50 No. 3 p.964 ~ p.974
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The Prognostic Impact of the Number of Metastatic Lymph Nodes and a New Prognostic Scoring System for Recurrence in Early-Stage Cervical Cancer with High Risk Factors: A Multicenter Cohort Study (KROG 15-04)
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Kwon Jeanny
Eom Keun-Young Kim Young-Seok Park Won Chun Mi-Son Lee Ji-Hae Kim Yong-Bae Yoon Won-Sup Kim Jin-Hee Choi Jin-Hwa Chang Sei-Kyung Jeong Bae-Kwon Lee Seok-Ho Cha Ji-Hye
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Abstract
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Purpose: We aimed to assess prognostic value of metastatic pelvic lymph node (mPLN) in early-stage cervical cancer treated with radical surgery followed by postoperative chemoradiotherapy. Also, we sought to define a high-risk group using prognosticators for recurrence.
Materials and Methods: A multicenter retrospective study was conducted using the data from 13 Korean institutions from 2000 to 2010. A total of 249 IB-IIA patients with high-risk factors were included. We evaluated distant metastasis-free survival (DMFS) and disease-free survival (DFS) in relation to clinicopathologic factors including pNstage, number of mPLN, lymph node (LN)ratio (number of positive LN/number of harvested LN), and log odds of mPLNs (log(number of positive LN+0.5/number of negative LN+0.5)).
Results: In univariate analysis, histology (squamous cell carcinoma [SqCC] vs. others), lymphovascular invasion (LVI), number of mPLNs (¡Â 3 vs. > 3), LN ratio (¡Â 17% vs. > 17%), and log odds of mPLNs (¡Â ?0.58 vs. > ?0.58) were significant prognosticators for DMFS and DFS. Resection margin involvement only affected DFS. No significant survival difference was observed between pN0 patients and patients with 1-3 mPLNs. Multivariate analysis revealed that mPLN > 3, LVI, and non-SqCC were unfavorable index for both DMFS (p < 0.001, p=0.020, and p=0.031, respectively) and DFS (p < 0.001, p=0.017, and p=0.001, respectively). A scoring system using these three factors predicts risk of recurrence with relatively high concordance index (DMFS, 0.69; DFS, 0.71).
Conclusion: mPLN > 3 in early-stage cervical cancer affects DMFS and DFS. A scoring system using mPLNs > 3, LVI, and non-SqCC could stratify risk groups of recurrence in surgically resected early-stage cervix cancer with high-risk factors.
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KEYWORD
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Uterine cervical neoplasms, Adjuvant treatment, Combined modality therapy, Lymphatic metastasis, Scoring system
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