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. 2023 Jan 3;3(1):96-101.
doi: 10.21873/cdp.10185. eCollection 2023 Jan-Feb.

Prognostic Factors of Cervical Adenocarcinoma With Positive Pelvic Lymph Node Metastases Without Preoperative Lymph Node Enlargement Treated With Radical Hysterectomy

Toshiaki Watanabe  1 , Natsuki Tamashiro  1 , Yuko Shimoji  1 , Yoshihisa Arakaki  1 , Yusuke Taira  1 , Tomoko Nakamoto  1 , Wataru Kudaka  1 , Yoichi Aoki  1
Affiliations

Prognostic Factors of Cervical Adenocarcinoma With Positive Pelvic Lymph Node Metastases Without Preoperative Lymph Node Enlargement Treated With Radical Hysterectomy

Toshiaki Watanabe et al. Cancer Diagn Progn. .

Abstract

Background/aim: Pelvic lymph node (LN) metastases are found histopathologically after radical hysterectomy (RH) in some cases of cervical adenocarcinoma with no enlarged LNs on preoperatively. The aim was to clarify whether LN metastasis is a prognostic factor in these patients, and whether any postoperative therapy is advisable.

Patients and methods: Sixty-one patients with stage I-II cervical adenocarcinoma [International Federation of Obstetrics and Gynecology (FIGO) 2008] with no enlarged pelvic LNs on preoperative imaging evaluation who underwent RH at our institution were retrospectively examined for clinicopathological, treatment, and prognosis-related factors.

Results: The median age was 47 years. FIGO stages were IB1 in 44 patients, IB2 in 10, IIA in 4, and IIB in 3. Seventeen patients (27.9%) had positive pelvic LNs. The multivariate analysis for both overall (OS) and disease-free (DFS) survival showed only pelvic LN metastasis was an independent prognostic factor. In a multivariate analysis of LN-positive cases, multiple LN metastases was an independent prognostic factor for poorer DFS. OS rates were 100%, 83.3%, and 30.0%, and DFS rates were 85.5%, 83.3%, and 12.5% for patients with no LN metastasis, single metastasis, and multiple metastases, respectively, showing a significant difference. Eight recurrences were observed in 10 patients with multiple node-positive disease, and six (75%) had an intrapelvic recurrence.

Conclusion: Among patients who underwent RH for cervical adenocarcinoma with no preoperative enlarged LN and positive pelvic LNs confirmed postoperatively, multiple positive pelvic LNs are an independent poor prognostic factor. Because pelvic recurrence is common, concurrent chemoradiotherapy, possibly using paclitaxel and cisplatin, should be considered as adjuvant therapy.

Keywords: Cervical adenocarcinoma; lymph node metastasis; no lymph node enlargement; prognostic factor.

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Conflict of interest statement

The Authors have no conflicts of interest to declare regarding this study.

Figures

Figure 1
Figure 1. Kaplan-Meier curves for overall survival (OS) of patients with lymph node-negative, single- lymph node (LN) metastasis, and multiple LN metastases. 5-Year OS. rates were 100%, 83.3%, and 30.0% (p<0.001), respectively, for the three groups. The only comparison that failed to reach significance was between the LN-negative and single metastasis groups in DFS.
Figure 2
Figure 2. Kaplan-Meier curves for disease-free survival (DFS) of patients with lymph node-negative, single- lymph node (LN) metastasis, and multiple LN metastases. 5-Year DFS rates were significantly different at 85.5%, 83.3%, and 12.5% (p<0.001), respectively, for the three groups.
See this image and copyright information in PMC

References

    1. Yoshino K, Kurita T, Takahashi F, Nagase S, Board members of the 2021 Committee on Gynecologic Oncology of the Japan Society of Obstetrics and Gynecology. Annual report of the committee on gynecologic oncology, the Japan Society of Obstetrics and Gynecology: Annual patient report for 2019 and annual treatment report for 2014. J Obstet Gynaecol Res. 2022;48(7):1570–1579. doi: 10.1111/jog.15284. - DOI - PubMed
    1. Hayabuchi N. Radiocurable tumors and non-radiocurable tumors. JMAJ. 2004;47:79–83.
    1. Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, Favini G, Ferri L, Mangioni C. Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet. 1997;350(9077):535–540. doi: 10.1016/S0140-6736(97)02250-2. - DOI - PubMed
    1. Chen YL, Ho CM, Chen CA, Chiang YC, Huang CY, Hsieh CY, Cheng WF. Impact of various treatment modalities on the outcome of stage IB1-IIA cervical adenocarcinoma. Int J Gynaecol Obstet. 2011;112(2):135–139. doi: 10.1016/j.ijgo.2010.08.016. - DOI - PubMed
    1. Shingleton HM, Bell MC, Fremgen A, Chmiel JS, Russell AH, Jones WB, Winchester DP, Clive RE. Is there really a difference in survival of women with squamous cell carcinoma, adenocarcinoma, and adenosquamous cell carcinoma of the cervix. Cancer. 1995;76(10 Suppl):1948–1955. doi: 10.1002/1097-0142(19951115)76:10+<1948::aid-cncr2820761311>3.0.co;2-t. - DOI - PubMed

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