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Abstract
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 (≤ 3 vs. > 3), LN ratio (≤ 17% vs. > 17%), and log odds of mPLNs (≤ -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.

Author information

Kwon J1, Eom KY2, Kim YS3, Park W4, Chun M5, Lee J6, Kim YB7, Yoon WS8, Kim JH9, Choi JH10, Chang SK11, Jeong BK12, Lee SH13, Cha J14.
1
Department of Radiation Oncology, Chungnam National University College of Medicine, Daejeon, Korea.
2
Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea.
3
Department of Radiation Oncology, Asan Medical center, University of Ulsan College of Medicine, Seoul, Korea.
4
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
5
Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea.
6
Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.
7
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
8
Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Korea.
9
Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
10
Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Korea.
11
Department of Radiation Oncology, CHA Bundang Medicial Center, CHA University School of Medicine, Seongnam, Korea.
12
Department of Radiation Oncology, Gyeongsang National University Hospital, Jinju, Korea.
13
Department of Radiation Oncology, Gachon University Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea.
14
Department of Radiation Oncology, Wonju Severance Christian Hospital, Wonju, Korea.