Prognostic analysis of patients with stage IIIC1p cervical cancer treated by surgery

Abstract

Background: Cervical cancer (CC) is one of the most common gynaecologic malignancies. The prognosis of stage IIIC1p cervical cancer patients treated by surgery is heterogeneous. Therefore, the aim of this study was to analyse the factors influencing the prognosis in such patients.

Methods: From January 2012 to December 2017, 102 patients with cervical cancer who underwent surgical treatment in the Department of Gynaecology and Tumours, Changzhou Maternal and Child Health Hospital, and had pelvic lymph node metastasis confirmed by pathology were analysed retrospectively. All patients underwent radical hysterectomy with/without oophorectomy with pelvic lymphadenectomy with/without para-aortic lymphadenectomy. Clinical data was collected including age, surgical method, ovarian status, intraoperative blood loss, perioperative complications, tumour size, pathological type, depth of stromal invasion (DSI), whether the lymphatic vascular space was infiltrated, number of pelvic lymph node metastases, location of pelvic lymph node metastases, total number of lymph nodes resected, lymph node ratio (LNR), nature of vaginal margin, whether parametrium was involved, postoperative adjuvant therapy, preoperative neutrophil-lymphocyte ratio (NLR) and prognostic information of patients. Survival curves for overall survival (OS) and disease-free survival (DFS) were plotted using the Kaplan-Meier method, and the difference between the survival curves was tested using the log-rank test. Univariate and multivariate COX regression models were used to assess the factors associated with overall survival and disease-free survival in patients with stage IIIC1p cervical cancer. Nomogram plots were constructed to predict OS and DFS, and the predictive accuracy of the nomograms was measured by Harrell's C-index and calibration curves.

Results: A total of 102 patients with stage IIIC1p cervical cancer were included in the study, and the median follow-up time was 63 months (range from 6 to 130 months). The 5-year OS was 64.7%, and the 5-year DFS was 62.7%. Multivariate analysis showed that no postoperative adjuvant therapy, LNR > 0.3 and NLR > 3.8 were independent risk factors for OS and DFS in patients with stage IIIC1p cervical cancer.

Conclusions: Patients with stage IIIC1p cervical cancer have a poor prognosis. Lower OS and DFS were associated with no postoperative adjuvant therapy, LNR > 0.3 and NLR > 3.8.

Keywords: Cervical cancer; Disease-free survival; Overall survival; Prognosis; Stage IIIC1p.

Fig. 1

A Overall survival in patients with stage IIIC1p cervical cancer. B Disease-free survival in patients with stage IIIC1p cervical cancer

Fig. 2

A The optimal cutoff value of age calculated by X-Tile software was 54. B The optimal cutoff value of intraoperative blood loss calculated by X-Tile software was 250. C The optimal cutoff value of LNR calculated by X-Tile software was 0.3. D The optimal cutoff value of NLR calculated by X-Tile software was 3.8

Fig. 3

A Overall survival curve for postoperative treatment. B Disease-free survival curve for postoperative treatment. C Overall survival curve for LNR. D Disease-free survival curve for LNR. E Overall survival curve for NLR. F Disease-free survival curve for NLR. G Overall survival curve for surgical method. H Disease-free survival curve for surgical method. LNR lymph node ratio, NLR neutrophil–lymphocyte ratio

Fig. 4

A Nomogram for predicting OS, which had a C-index of 0.800. B Calibration curve to predict 5-year OS. C Nomogram for predicting DFS, which had a C-index of 0.798. D Calibration curve to predict 5-year DFS. OS overall survival, DFS disease-free survival, NLR neutrophil–lymphocyte ratio