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. 2022 May;101(5):550-557.
doi: 10.1111/aogs.14316. Epub 2022 Feb 26.

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

Ester P Olthof  1   2 , Constantijne H Mom  2 , Malou L H Snijders  3 , Hans H B Wenzel  1 , Jacobus van der Velden  2 , Maaike A van der Aa  1
Affiliations

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

Ester P Olthof et al. Acta Obstet Gynecol Scand. 2022 May.

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.

Keywords: lymph node metastasis; lymph node ratio; radical surgery; survival; uterine cervical cancer.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier curves, 5‐year overall survival categorized by low‐ and high‐risk groups for number of lymph node metastases
FIGURE 2
FIGURE 2
Kaplan–Meier curves, 5‐year overall survival categorized by low‐ and high‐risk groups for lymph node ratio
See this image and copyright information in PMC

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