Skip to main content
Top
Published in: Cancer Cell International 1/2013

Open Access 01-12-2013 | Primary research

Combining the negative lymph nodes count with the ratio of positive and removed lymph nodes can better predict the postoperative survival in cervical cancer patients

Authors: Ying Chen, Lei Zhang, Jing Tian, Xiubao Ren, Quan Hao

Published in: Cancer Cell International | Issue 1/2013

Login to get access

Abstract

Background

To evaluate the impacts of the negative lymph nodes (NLNs) count on the prognostic prediction of the ratio of positive and removed lymph nodes (RPL) in cervical cancer patients after radical hysterectomy and pelvic lymphadenectomy (RHPL).

Methods

The positive and negative lymph node counts were calculated for 609 postoperative cervical cancer patients. The 5-year survival rate (5-YSR) was examined according to clinicopathologic variables. Cox regression was used to identify independent prognostic factors.

Results

The NLNs count cutoffs were determined to be 10 and 25 with 5-YSR of 62.8% and 80.5%. The RPL of 13 patients who had the NLNs count of 10 or fewer was >20%. Among 242 patients who had 10 < NLNs count ≤ 25, 194 without positive nodes had the 5-YSR of 77.8%, 31 with 0% < RPL ≤ 5% had the 5-YSR of 3.2%, 15 with RPL > 20% had died when follow-up was completed. Among 354 patients who had NLNs count >25, 185 without positive nodes had the 5-YSR of 87.6%, 6 with 0% < RPL ≤ 5% had the 5-YSR of 25%, 15 with 5% < RPL ≤ 20% had the 5-YSR of 4.5%, and 2 with RPL >20% had died when follow-up was completed. Furthermore, stage, histologic grade and RPL were independently correlated with overall survival of cervical cancer patients after RHPL in the multivariate analysis.

Conclusions

RPL was an independent prognostic factor. The NLNs count is a key factor for improvement of survival prediction of RPL in cervical cancer.
Appendix
Available only for authorised users
Literature
1.
go back to reference Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D: Global cancer statistics. CA Cancer J Clin. 2011, 61: 69-90. 10.3322/caac.20107.CrossRefPubMed Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D: Global cancer statistics. CA Cancer J Clin. 2011, 61: 69-90. 10.3322/caac.20107.CrossRefPubMed
2.
go back to reference Sevin BU, Nadji M, Lampe B, Lu Y, Hilsenbeck S, Koechli O: Prognostic factors in early stage cervical carcinoma treated with radical hysterectomy. Cancer. 1995, 76: 1978-1986. 10.1002/1097-0142(19951115)76:10+<1978::AID-CNCR2820761313>3.0.CO;2-K.CrossRefPubMed Sevin BU, Nadji M, Lampe B, Lu Y, Hilsenbeck S, Koechli O: Prognostic factors in early stage cervical carcinoma treated with radical hysterectomy. Cancer. 1995, 76: 1978-1986. 10.1002/1097-0142(19951115)76:10+<1978::AID-CNCR2820761313>3.0.CO;2-K.CrossRefPubMed
3.
go back to reference Kim HS, Park NH, Wu HG, Cho JY, Chung HH, Kim JW: Matched-case comparison for the role of surgery in FIGO stage Ib1–IIa squamous cell carcinoma of cervix and suspicious para-aortic lymph node metastasis. Ann Surg Oncol. 2009, 16: 133-139. 10.1245/s10434-008-0197-3.CrossRefPubMed Kim HS, Park NH, Wu HG, Cho JY, Chung HH, Kim JW: Matched-case comparison for the role of surgery in FIGO stage Ib1–IIa squamous cell carcinoma of cervix and suspicious para-aortic lymph node metastasis. Ann Surg Oncol. 2009, 16: 133-139. 10.1245/s10434-008-0197-3.CrossRefPubMed
4.
go back to reference Hosaka M, Watari H, Mitamura T, Konno Y, Odagiri T, Kato T: Survival and prognosticators of node-positive cervical cancer patients treated with radical hysterectomy and systematic lymphadenectomy. Int J Clin Oncol. 2011, 16: 33-38. 10.1007/s10147-010-0123-0.CrossRefPubMed Hosaka M, Watari H, Mitamura T, Konno Y, Odagiri T, Kato T: Survival and prognosticators of node-positive cervical cancer patients treated with radical hysterectomy and systematic lymphadenectomy. Int J Clin Oncol. 2011, 16: 33-38. 10.1007/s10147-010-0123-0.CrossRefPubMed
5.
go back to reference Pieterse QD, Kenter GG, Gaarenstroom KN, Peters AA, Willems SM, Fleuren GJ: The number of pelvic lymph nodes in the quality control and prognosis of radical hysterectomy for the treatment of cervical cancer. Eur J Surg Oncol. 2007, 33: 216-221. 10.1016/j.ejso.2006.09.037.CrossRefPubMed Pieterse QD, Kenter GG, Gaarenstroom KN, Peters AA, Willems SM, Fleuren GJ: The number of pelvic lymph nodes in the quality control and prognosis of radical hysterectomy for the treatment of cervical cancer. Eur J Surg Oncol. 2007, 33: 216-221. 10.1016/j.ejso.2006.09.037.CrossRefPubMed
6.
go back to reference Kim HS, Kim JH, Chung HH, Kim HJ, Kim YB, Kim JW: Significance of numbers of metastatic and removed lymph nodes in FIGO stage IB1 to IIA cervical cancer: primary surgical treatment versus neoadjuvant chemotherapy before surgery. Gynecol Oncol. 2011, 121: 551-557. 10.1016/j.ygyno.2011.01.024.CrossRefPubMed Kim HS, Kim JH, Chung HH, Kim HJ, Kim YB, Kim JW: Significance of numbers of metastatic and removed lymph nodes in FIGO stage IB1 to IIA cervical cancer: primary surgical treatment versus neoadjuvant chemotherapy before surgery. Gynecol Oncol. 2011, 121: 551-557. 10.1016/j.ygyno.2011.01.024.CrossRefPubMed
7.
go back to reference Shah M, Lewin SN, Deutsch I, Burke WM, Sun X, Herzog TJ: Therapeutic role of lymphadenectomy for cervical cancer. Cancer. 2011, 117: 310-317. 10.1002/cncr.25408.CrossRefPubMed Shah M, Lewin SN, Deutsch I, Burke WM, Sun X, Herzog TJ: Therapeutic role of lymphadenectomy for cervical cancer. Cancer. 2011, 117: 310-317. 10.1002/cncr.25408.CrossRefPubMed
8.
go back to reference Prapaporn S, Kittipat C, Surapan K: Pelvic node removal and disease-free survival in cervical cancer patients treated with radical hysterectomy and pelvic lymphadenectomy. Int J Gynecol Obstet. 2012, 116: 43-46. 10.1016/j.ijgo.2011.08.001.CrossRef Prapaporn S, Kittipat C, Surapan K: Pelvic node removal and disease-free survival in cervical cancer patients treated with radical hysterectomy and pelvic lymphadenectomy. Int J Gynecol Obstet. 2012, 116: 43-46. 10.1016/j.ijgo.2011.08.001.CrossRef
9.
go back to reference Soliman PT, Frumovitz M, Sun CC, Dos Reis R, Schmeler KM, Nick AM: Radical hysterectomy: a comparison of surgical approaches after adoption of robotic surgery in gynecologic oncology. Gynecol Oncol. 2011, 123: 333-336. 10.1016/j.ygyno.2011.08.001.PubMedCentralCrossRefPubMed Soliman PT, Frumovitz M, Sun CC, Dos Reis R, Schmeler KM, Nick AM: Radical hysterectomy: a comparison of surgical approaches after adoption of robotic surgery in gynecologic oncology. Gynecol Oncol. 2011, 123: 333-336. 10.1016/j.ygyno.2011.08.001.PubMedCentralCrossRefPubMed
10.
go back to reference Metindir J, Bilir G: Impact of the ratio of metastatic to examined lymph nodes on the survival of early-stage cervical cancer patients. Onkologie. 2009, 32: 103-106. 10.1159/000197361.CrossRefPubMed Metindir J, Bilir G: Impact of the ratio of metastatic to examined lymph nodes on the survival of early-stage cervical cancer patients. Onkologie. 2009, 32: 103-106. 10.1159/000197361.CrossRefPubMed
11.
go back to reference Polterauer S, Hefler L, Seebacher V, Rahhal J, Tempfer C, Horvat R: The impact of lymph node density on survival of cervical cancer patients. Brit J Cancer. 2010, 103: 613-616. 10.1038/sj.bjc.6605801.PubMedCentralCrossRefPubMed Polterauer S, Hefler L, Seebacher V, Rahhal J, Tempfer C, Horvat R: The impact of lymph node density on survival of cervical cancer patients. Brit J Cancer. 2010, 103: 613-616. 10.1038/sj.bjc.6605801.PubMedCentralCrossRefPubMed
12.
go back to reference Verleye L, Vergote I, Reed N, Ottevanger PB: Quality assurance for radical hysterectomy for cervical cancer: the view of the European organization for research and treatment of cancer–gynecological cancer group (EORTC-GCG). Ann Oncol. 2009, 20: 1631-1638. 10.1093/annonc/mdp196.CrossRefPubMed Verleye L, Vergote I, Reed N, Ottevanger PB: Quality assurance for radical hysterectomy for cervical cancer: the view of the European organization for research and treatment of cancer–gynecological cancer group (EORTC-GCG). Ann Oncol. 2009, 20: 1631-1638. 10.1093/annonc/mdp196.CrossRefPubMed
13.
go back to reference Kasamatsu T, Onda T, Sawada M, Kato T, Ikeda S: Radical hysterectomy for FIGO stage IIB cervical cancer: clinicopathological characteristics and prognostic evaluation. Gynecol Oncol. 2009, 114: 69-74. 10.1016/j.ygyno.2009.03.026.CrossRefPubMed Kasamatsu T, Onda T, Sawada M, Kato T, Ikeda S: Radical hysterectomy for FIGO stage IIB cervical cancer: clinicopathological characteristics and prognostic evaluation. Gynecol Oncol. 2009, 114: 69-74. 10.1016/j.ygyno.2009.03.026.CrossRefPubMed
14.
go back to reference Marchet A, Mocellin S, Ambrosi A, Morgagni P, Garcea D, Marrelli D: Italian research group for gastric cancer (IRGGC). the ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastriccancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients. Ann Surg. 2007, 245: 543-552. 10.1097/01.sla.0000250423.43436.e1.PubMedCentralCrossRefPubMed Marchet A, Mocellin S, Ambrosi A, Morgagni P, Garcea D, Marrelli D: Italian research group for gastric cancer (IRGGC). the ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastriccancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients. Ann Surg. 2007, 245: 543-552. 10.1097/01.sla.0000250423.43436.e1.PubMedCentralCrossRefPubMed
15.
go back to reference Berger AC, Sigurdson ER, LeVoyer T, Hanlon A, Mayer RJ, Macdonald JS: Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol. 2005, 23: 8706-8712. 10.1200/JCO.2005.02.8852.CrossRefPubMed Berger AC, Sigurdson ER, LeVoyer T, Hanlon A, Mayer RJ, Macdonald JS: Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol. 2005, 23: 8706-8712. 10.1200/JCO.2005.02.8852.CrossRefPubMed
16.
go back to reference Wilson M, Rosato EL, Chojnacki KA, Chervoneva I, Kairys JC, Cohn HE: Prognostic significance of lymph node metastases and ratio in esophageal cancer. J Surg Research. 2008, 146: 11-15. 10.1016/j.jss.2007.07.028.CrossRef Wilson M, Rosato EL, Chojnacki KA, Chervoneva I, Kairys JC, Cohn HE: Prognostic significance of lymph node metastases and ratio in esophageal cancer. J Surg Research. 2008, 146: 11-15. 10.1016/j.jss.2007.07.028.CrossRef
17.
go back to reference Mahdi H, Thrall M, Kumar S, Hanna R, Seward S, Lockhart D: The prognostic impact of the ratio of positive lymph nodes on survival of epithelial ovarian cancer patients. J Surg Oncol. 2011, 103: 724-729. 10.1002/jso.21869.CrossRefPubMed Mahdi H, Thrall M, Kumar S, Hanna R, Seward S, Lockhart D: The prognostic impact of the ratio of positive lymph nodes on survival of epithelial ovarian cancer patients. J Surg Oncol. 2011, 103: 724-729. 10.1002/jso.21869.CrossRefPubMed
18.
go back to reference Chan JK, Kapp DS, Cheung MK, Osann K, Shin JY, Cohn D: The impact of the absolute number and ratio of positive lymph nodes on survival of endometrioid uterine cancer patients. Br J Cancer. 2007, 97: 605-611. 10.1038/sj.bjc.6603898.PubMedCentralCrossRefPubMed Chan JK, Kapp DS, Cheung MK, Osann K, Shin JY, Cohn D: The impact of the absolute number and ratio of positive lymph nodes on survival of endometrioid uterine cancer patients. Br J Cancer. 2007, 97: 605-611. 10.1038/sj.bjc.6603898.PubMedCentralCrossRefPubMed
19.
go back to reference Polterauer S, Khalil S, Zivanovic O, Abu-Rustum NR, Hofstetter G, Concin N: Prognostic value of lymph node ratio and clinicopathologic parameters in patients diagnosed with stage IIIC endometrial cancer. Obstet Gynecol. 2012, 119: 1210-1218. 10.1097/AOG.0b013e318255060c.CrossRefPubMed Polterauer S, Khalil S, Zivanovic O, Abu-Rustum NR, Hofstetter G, Concin N: Prognostic value of lymph node ratio and clinicopathologic parameters in patients diagnosed with stage IIIC endometrial cancer. Obstet Gynecol. 2012, 119: 1210-1218. 10.1097/AOG.0b013e318255060c.CrossRefPubMed
20.
go back to reference Schwarz RE, Smith DD: Clinical impact of lymphadenectomy extent in respectable gastric cancer of advanced stage. Ann Surg Oncol. 2007, 14: 317-328. 10.1245/s10434-006-9218-2.CrossRefPubMed Schwarz RE, Smith DD: Clinical impact of lymphadenectomy extent in respectable gastric cancer of advanced stage. Ann Surg Oncol. 2007, 14: 317-328. 10.1245/s10434-006-9218-2.CrossRefPubMed
21.
go back to reference Johnson PM, Porter GA, Ricciardi R, Baxter NN: Increasing negative lymph node count is independently associated with improved long-term survival in stage IIIB and IIIC colon cancer. J Clin Oncol. 2006, 24: 3570-3575. 10.1200/JCO.2006.06.8866.CrossRefPubMed Johnson PM, Porter GA, Ricciardi R, Baxter NN: Increasing negative lymph node count is independently associated with improved long-term survival in stage IIIB and IIIC colon cancer. J Clin Oncol. 2006, 24: 3570-3575. 10.1200/JCO.2006.06.8866.CrossRefPubMed
22.
go back to reference Cote RJ, Peterson HF, Chaiwun B, Gelber RD, Goldhirsch A, Castiglione-Gertsch M: Role of immunohistochemical detection of lymph-node metastases in management of breast cancer. International breast cancer study group. Lancet. 1999, 354: 896-900. 10.1016/S0140-6736(98)11104-2.CrossRefPubMed Cote RJ, Peterson HF, Chaiwun B, Gelber RD, Goldhirsch A, Castiglione-Gertsch M: Role of immunohistochemical detection of lymph-node metastases in management of breast cancer. International breast cancer study group. Lancet. 1999, 354: 896-900. 10.1016/S0140-6736(98)11104-2.CrossRefPubMed
23.
go back to reference International (Ludwig) Breast Cancer Study Group: Prognostic importance of occult axillary lymph node micrometastases from breast cancers. Lancet. 1990, 355: 1565-1568. International (Ludwig) Breast Cancer Study Group: Prognostic importance of occult axillary lymph node micrometastases from breast cancers. Lancet. 1990, 355: 1565-1568.
24.
go back to reference Juretzka MM, Jensen KC, Longacre TA, Teng NN, Husain A: Detection of pelvic lymph node micrometastasis in stage IA2–IB2 cervical cancer by immunohistochemical analysis. Gynecol Oncol. 2004, 93 (1): 107-111. 10.1016/j.ygyno.2003.11.033.CrossRefPubMed Juretzka MM, Jensen KC, Longacre TA, Teng NN, Husain A: Detection of pelvic lymph node micrometastasis in stage IA2–IB2 cervical cancer by immunohistochemical analysis. Gynecol Oncol. 2004, 93 (1): 107-111. 10.1016/j.ygyno.2003.11.033.CrossRefPubMed
25.
go back to reference Lentz SE, Muderspach LI, Felix JC, Ye W, Groshen S, Amezcua CA: Identification of micrometastases in histologically negative lymph nodes of early-stage cervical cancer patients. Obstet Gynecol. 2004, 103 (6): 1204-10. 10.1097/01.AOG.0000125869.78251.5e.CrossRefPubMed Lentz SE, Muderspach LI, Felix JC, Ye W, Groshen S, Amezcua CA: Identification of micrometastases in histologically negative lymph nodes of early-stage cervical cancer patients. Obstet Gynecol. 2004, 103 (6): 1204-10. 10.1097/01.AOG.0000125869.78251.5e.CrossRefPubMed
26.
go back to reference Takeda N, Sakuragi N, Takeda M, Okamoto K, Kuwabara M, Negishi H: Multivariate analysis of histopathologic prognostic factors for invasive cervical cancer treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy. Acta Obstet Gynecol Scand. 2002, 81: 1144-1151. 10.1034/j.1600-0412.2002.811208.x.CrossRefPubMed Takeda N, Sakuragi N, Takeda M, Okamoto K, Kuwabara M, Negishi H: Multivariate analysis of histopathologic prognostic factors for invasive cervical cancer treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy. Acta Obstet Gynecol Scand. 2002, 81: 1144-1151. 10.1034/j.1600-0412.2002.811208.x.CrossRefPubMed
27.
go back to reference Smith DD, Schwarz RR, Schwarz RE: Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol. 2005, 23: 7114-7124. 10.1200/JCO.2005.14.621.CrossRefPubMed Smith DD, Schwarz RR, Schwarz RE: Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol. 2005, 23: 7114-7124. 10.1200/JCO.2005.14.621.CrossRefPubMed
Metadata
Title
Combining the negative lymph nodes count with the ratio of positive and removed lymph nodes can better predict the postoperative survival in cervical cancer patients
Authors
Ying Chen
Lei Zhang
Jing Tian
Xiubao Ren
Quan Hao
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Cancer Cell International / Issue 1/2013
Electronic ISSN: 1475-2867
DOI
https://doi.org/10.1186/1475-2867-13-6

Other articles of this Issue 1/2013

Cancer Cell International 1/2013 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine