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. 2020 Apr;8(7):485.
doi: 10.21037/atm.2020.03.27.

Validation of the prognostic value of various lymph node staging systems for cervical squamous cell carcinoma following radical surgery: a single-center analysis of 3,732 patients

Qinhao Guo  1   2 , Jun Zhu  1   2 , Yong Wu  1   2 , Hao Wen  1   2 , Lingfang Xia  1   2 , Xingzhu Ju  1   2 , Guihao Ke  1   2 , Xiaohua Wu  1   2
Affiliations

Validation of the prognostic value of various lymph node staging systems for cervical squamous cell carcinoma following radical surgery: a single-center analysis of 3,732 patients

Qinhao Guo et al. Ann Transl Med. 2020 Apr.

Abstract

Background: To investigate the prognostic value of six lymph nodes (LNs) staging systems: TNM pN stage, 2018 Federation International of Gynecology and Obstetrics (FIGO) stage, number of positive LNs (PLN), number of negative LNs (NLN), metastatic LN ratio (LNR), and log odds of positive LNs (LODDS) in cervical squamous cell carcinoma (CSCC) patients following radical surgery.

Methods: The records of 3,732 CSCC patients who underwent radical surgery between 2006 and 2014 were retrospectively reviewed. We divided variables into different groups by applying tree-based recursive partitioning. Survival curves were compared by the log-rank test, and prognostic factors were identified through Cox regression analysis. The six staging systems underwent assessment for their relative discriminative abilities by way of Harrell's concordance index (C-index) and the Akaike's Information Criterion (AIC).

Results: All of the six staging systems had a significant influence on patients' progression-free survival (PFS) and overall survival (OS), with univariate analysis showing all of the staging systems to have the significant prognostic ability in relation to PFS and OS (P<0.001 for each). Multivariate analysis demonstrated five of the staging methods to be independent prognostic factors, but that NLN classification was not. PLN was noted to have somewhat the best prognostic performance for both PFS (C-index: 0.634; AIC: 33,343.83) and OS (C-index: 0.675; AIC: 34,223.11).

Conclusions: The pN, 2018 FIGO stage, PLN, LNR, and LODDS appeared to predict better survival than the NLN in CSCC patients. Moreover, PLN appeared to be the most valuable and predictive LN staging system.

Keywords: Akaike’s Information Criterion (AIC); C-index; LN staging systems; cervical squamous cell carcinoma (CSCC); lymph node (LN); prognostic value.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm.2020.03.27). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Kaplan-Meier curves for PFS stratified by LN categories based on the pN stage (A), 2018 FIGO stage (B), PLN (C), NLN (D), LNR (E), and LODDS (F). PFS, progression-free survival; LN, lymph node; FIGO, Federation of Gynecology and Obstetrics; PLN, positive lymph nodes; NLN, negative lymph nodes; LNR, lymph node ratio; LODDS, log odds of positive nodes.
Figure 2
Figure 2
Kaplan-Meier curves for OS stratified by LN categories based on the pN stage (A), 2018 FIGO stage (B), PLN (C), NLN (D), LNR (E), and LODDS (F). OS, overall survival; LN, lymph node; FIGO, Federation of Gynecology and Obstetrics; PLN, positive lymph nodes; NLN, negative lymph nodes; LNR, lymph node ratio; LODDS, log odds of positive nodes.
Figure 3
Figure 3
The correlations between PLN and LNR (A), LODDS and PLN (B), LNR and LODDS (C), LODDS and NLN (D), NLN and LNR (E), and PLN and NLN (F). PLN, positive lymph nodes; NLN, negative lymph nodes; LNR, lymph node ratio; LODDS, log odds of positive nodes.
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