The Prognostic Impact of the Number of Metastatic Lymph Nodes and a New Prognostic Scoring System for Recurrence in Early-Stage Cervical Cancer with High Risk Factors: A Multicenter Cohort Study (KROG 15-04)
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Purpose We aimed to assess prognostic value of metastatic pelvic lymph node (mPLN) in early-stage cervical cancer treated with radical surgery followed by postoperative chemoradiotherapy. Also, we sought to define a high-risk group using prognosticators for recurrence. Materials and Methods A multicenter retrospective study was conducted using the data from 13 Korean institutions from 2000 to 2010. A total of 249 IB-IIA patients with high-risk factors were included. We evaluated distant metastasis-free survival (DMFS) and disease-free survival (DFS) in relation to clinicopathologic factors including pN stage, number of mPLN, lymph node (LN) ratio (number of positive LN/number of harvested LN), and log odds of mPLNs (log(number of positive LN+0.5/number of negative LN+0.5)). Results In univariate analysis, histology (squamous cell carcinoma [SqCC] vs. others), lymphovascular invasion (LVI), number of mPLNs ( 3 vs. > 3), LN ratio ( 17% vs. > 17%), and log odds of mPLNs ( 0.58 vs. > 0.58) were significant prognosticators for DMFS and DFS. Resection margin involvement only affected DFS. No significant survival difference was observed between pN0 patients and patients with 1-3 mPLNs. Multivariate analysis revealed that mPLN > 3, LVI, and non-SqCC were unfavorable index for both DMFS (p < 0.001, p=0.020, and p=0.031, respectively) and DFS (p < 0.001, p=0.017, and p=0.001, respectively). A scoring system using these three factors predicts risk of recurrence with relatively high concordance index (DMFS, 0.69; DFS, 0.71). Conclusion mPLN > 3 in early-stage cervical cancer affects DMFS and DFS. A scoring system using mPLNs > 3, LVI, and non-SqCC could stratify risk groups of recurrence in surgically resected early-stage cervix cancer with high-risk factors.
Abstract
Purpose We aimed to assess prognostic value of metastatic pelvic lymph node (mPLN) in early-stage cervical cancer treated with radical surgery followed by postoperative chemoradiotherapy. Also, we sought to define a high-risk group using prognosticators for recurrence. Materials and Methods A multicenter retrospective study was conducted using the data from 13 Korean institutions from 2000 to 2010. A total of 249 IB-IIA patients with high-risk factors were included. We evaluated distant metastasis-free survival (DMFS) and disease-free survival (DFS) in relation to clinicopathologic factors including pN stage, number of mPLN, lymph node (LN) ratio (number of positive LN/number of harvested LN), and log odds of mPLNs (log(number of positive LN+0.5/number of negative LN+0.5)). Results In univariate analysis, histology (squamous cell carcinoma [SqCC] vs. others), lymphovascular invasion (LVI), number of mPLNs ( 3 vs. > 3), LN ratio ( 17% vs. > 17%), and log odds of mPLNs ( 0.58 vs. > 0.58) were significant prognosticators for DMFS and DFS. Resection margin involvement only affected DFS. No significant survival difference was observed between pN0 patients and patients with 1-3 mPLNs. Multivariate analysis revealed that mPLN > 3, LVI, and non-SqCC were unfavorable index for both DMFS (p < 0.001, p=0.020, and p=0.031, respectively) and DFS (p < 0.001, p=0.017, and p=0.001, respectively). A scoring system using these three factors predicts risk of recurrence with relatively high concordance index (DMFS, 0.69; DFS, 0.71). Conclusion mPLN > 3 in early-stage cervical cancer affects DMFS and DFS. A scoring system using mPLNs > 3, LVI, and non-SqCC could stratify risk groups of recurrence in surgically resected early-stage cervix cancer with high-risk factors.
참고문헌 (30)
- 정규원, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2014", Cancer Research and Treatment, 49(2), pp.292~305 (2017), 대한암학회
- 문은경, "Trends and Age-Period-Cohort Effects on the Incidence and Mortality Rate of Cervical Cancer in Korea", Cancer Research and Treatment, 49(2), pp.526~533 (2017), 대한암학회
- Nowakowski A, "Cervical cancer histology, staging and survival before and after implementation of organised cervical screening programme in Poland", PLoS One, 11, pp.e0155849~ (2016)[DOI]
- Landoni F, "Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer", Lancet, 350, pp.535~540 (1997)[DOI]
- Peters WA 3rd, "Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix", J Clin Oncol, 18, pp.1606~1613 (2000)[DOI]
- Kidd EA, "Lymph node staging by positron emission tomography in cervical cancer: relationship to prognosis", J Clin Oncol, 28, pp.2108~2113 (2010)[DOI]
- [URL]
- Delgado G, "Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study", Gynecol Oncol, 38, pp.352~357 (1990)[DOI]
- Stehman FB, "Carcinoma of the cervix treated with radiation therapy. I. A multi-variate analysis of prognostic variables in the Gynecologic Oncology Group", Cancer, 67, pp.2776~2785 (1991)[DOI]
- Tsai CS, "The prognostic factors for patients with early cervical cancer treated by radical hysterectomy and postoperative radiotherapy", Gynecol Oncol, 75, pp.328~333 (1999)[DOI]
- Lee HJ, "Individualized prediction of overall survival after postoperative radiation therapy in patients with early-stage cervical cancer: a Korean Radiation Oncology Group study (KROG 13-03)", Int J Radiat Oncol Biol Phys, 87, pp.659~664 (2013)[DOI]
- 권진이, "Prognostic Value of Log Odds of Positive Lymph Nodes after Radical Surgery Followed by Adjuvant Treatment in High-Risk Cervical Cancer", Cancer Research and Treatment, 48(2), pp.632~640 (2016), 대한암학회
- Pecorelli S, "Revised FIGO staging for carcinoma of the cervix", Int J Gynaecol Obstet, 105, pp.107~108 (2009)[DOI]
- Compton CC, "AJCC cancer staging atlas: a companion to the seventh editions of the AJCC cancer staging manual and handbook" (2012), Springer
- Monk BJ, "Rethinking the use of radiation and chemotherapy after radical hysterectomy: a clinical-pathologic analysis of a Gynecologic Oncology Group", Southwest Oncology Group, Gynecol Oncol, pp.2005, 96[DOI]
- Sedlis A, "A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a Gynecologic Oncology Group Study", Gynecol Oncol, 73, pp.177~183 (1999)[DOI]
- Fleming ND, "Significance of lymph node ratio in defining risk category in node-positive early stage cervical cancer", Gynecol Oncol, 136, pp.48~53 (2015)[DOI]
- Li C, "Prognostic significance of metastatic lymph node ratio in squamous cell carcinoma of the cervix", Onco Targets Ther, 9, pp.3791~3797 (2016)
- Polterauer S, "The impact of lymph node density on survival of cervical cancer patients", Br J Cancer, 103, pp.613~616 (2010)[DOI]
- Chen Y, "Significance of the absolute number and ratio of metastatic lymph nodes in predicting postoperative survival for the International Federation of Gynecology and Obstetrics stage IA2 to IIA cervical cancer", Int J Gynecol Cancer, 23, pp.157~163 (2013)[DOI]
- Zhou J, "Prognostic value of lymph node ratio in patients with small-cell carcinoma of the cervix based on data from a large national registry", Onco Targets Ther, 9, pp.67~73 (2015)
- Aurello P, "Log odds of positive lymph nodes (LODDS): what are their role in the prognostic assessment of gastric adenocarcinoma?", J Gastrointest Surg, 18, pp.1254~1260 (2014)[DOI]
- Morice P, "Prognostic value of lymphovascular space invasion determined with hematoxylin-eosin staining in early stage cervical carcinoma: results of a multivariate analysis", Ann Oncol, 14, pp.1511~1517 (2003)[DOI]
- Chandacham A, "Extent of lymphovascular space invasion and risk of pelvic lymph node metastases in stage IB1 cervical cancer", J Med Assoc Thai, 88(Suppl 2), pp.S31~S36 (2005)
- Hosaka M, "Survival and prognosticators of node-positive cervical cancer patients treated with radical hysterectomy and systematic lymphadenectomy", Int J Clin Oncol, 16, pp.33~38 (2011)[DOI]
- 김현주, "Clinical outcomes of adjuvant radiation therapy and prognostic factors in early stage uterine cervical cancer", Radiation oncology journal, 33(2), pp.126~133 (2015), 대한방사선종양학회
- Galic V, "Prognostic significance of adenocarcinoma histology in women with cervical cancer", Gynecol Oncol, 125, pp.287~291 (2012)[DOI]
- Intaraphet S, "Prognostic impact of histology in patients with cervical squamous cell carcinoma, adenocarcinoma and small cell neuroendocrine carcinoma", Asian Pac J Cancer Prev, 14, pp.5355~5360 (2013)[DOI]
- Winer I, "The prognostic significance of histologic type in early stage cervical cancer: a multi-institutional study", Gynecol Oncol, 137, pp.474~478 (2015)[DOI]
- Mabuchi S, "Impact of histological subtype on survival of patients with surgically-treated stage IA2-IIB cervical cancer: adenocarcinoma versus squamous cell carcinoma", Gynecol Oncol, 127, pp.114~120 (2012)[DOI]