Tumor size and lymph node status determined by imaging are reliable factors for predicting advanced cervical cancer prognosis

Abstract

The aim of the present study was to investigate the prognostic role of a number of clinical factors in advanced cervical cancer patients. Patients (n=157) with stage IIA-IIB cervical cancer treated at four Hallym Medical Centers in South Korea (Hallym University Sacred Heart Hospital; Kangnam Sacred Heart Hospital; Chuncheon Sacred Heart Hospital; and Kangdong Sacred Heart Hospital) between 2006 and 2010 were retrospectively enrolled. Univariate analysis identified significant predictive values in the following eight factors: i) Cancer stage (P<0.0001); ii) tumor size (≤4 vs. 4-6 cm, P=0.0147; and ≤4 vs. >6 cm, P<0.0001); iii) serum squamous cell carcinoma antigen level (≤2 vs. >15 ng/ml; P=0.0291); iv) lower third vaginal involvement (P<0.0001); v) hydronephrosis (P=0.0003); vi) bladder/rectum involvement (P=0.0015); vii) pelvic (P=0.0017) or para-aortic (P=0.0019) lymph node (LN) metastasis detected by imaging vs. no metastasis; and viii) pelvic LN metastasis identified by pathological analysis (P=0.0289). Furthermore, multivariate analysis determined that tumor size (≤4 vs. 4-6 cm, P=0.0371; and ≤4 vs. >6 cm, P=0.0024) and pelvic LN metastasis determined by imaging vs. no metastasis (P=0.0499) were independent predictive variables. Therefore, tumor size and pelvic LN metastasis measured by imaging were independent predictive factors for the prognosis of advanced cervical cancer. These factors may provide more clinically significant prognostic information compared with the currently used International Federation of Gynecology and Obstetrics staging system.

Keywords: pelvic lymph node; prognosis; tumor size; uterine cervical cancer.

Figure 1.

Kaplan-Meier analysis of stage-specific overall survival for all eligible advanced cervical cancer patients. The mean survival rate was 39.91 months for stage IIA, 50.60 months for stage IIB, 14.34 months for stage III and 28.67 months for stage IV cervical cancer. Significant differences in survival rate were identified between the different stages (log-rank test, P<0.0001); however, the survival rates of stage IIA vs. IIB and stage III vs. IV intersected.

Figure 2.

Kaplan-Meier analysis of overall survival according to (A) tumor size and (B) LN metastasis. Statistically significant differences in survival were identified among the various tumor sizes and the presence of LN metastasis detected by imaging. The mean survival rate of patients with tumors measuring a maximum diameter of ≤4, 4–6 and >6 cm were 66.1, 50.3 and 38.3 months, respectively (log-rank test, P=0.000). The mean survival rates of patients with no LN, pelvic LN and para-aortic LN metastasis were 60.9, 49.3 and 22.0 months, respectively (log-rank test, P=0.001). LN, lymph node.