The impact of examined lymph node count on survival in squamous cell carcinoma and adenocarcinoma of the uterine cervix
Received 8 May 2017
Accepted for publication 14 June 2017
Published 18 July 2017 Volume 2017:9 Pages 315—322
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Akshita Wason
Peer reviewer comments 2
Editor who approved publication: Dr Alexandra R. Fernandes
Juan Zhou,1,* Wen-Wen Zhang,2,* San-Gang Wu,3 Zhen-Yu He,2 Jia-Yuan Sun,2 Yan Wang,4 Qiong-Hua Chen1
1Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, 2Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 3Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, 4Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
*These authors contributed equally to this work.
Introduction: The prognostic impact of the number of examined lymph nodes (ELNs) in different histological subtypes of cervical cancer remains unclear. We aimed to assess the impact of the number of ELNs in stage IA2–IIA cervical cancer with different histological subtypes.
Methods: Data of patients with stage IA2–IIA squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the uterine cervix between 1988 and 2013 were retrieved from the Surveillance, Epidemiology, and End Results program. Univariate and multivariate Cox regression analyses were performed to analyze the effect of number of ELNs on cause-specific survival (CSS) and overall survival (OS).
Results: The final data set identified 11,830 patients including 7,920 (66.9%) women with SCC and 3,910 (33.1%) with AC. The median number of ELNs was 19. The multivariate analysis indicated that the number of ELNs was an independent prognostic factor influencing CSS and OS, both as a continuous or a categorical variable. Patients with a higher number of ELNs had better survival outcomes. In SCC subtype, the number of ELNs was also the independent prognostic factor of CSS and OS in node-positive patients, but not in patients with node-negative disease. In AC patients, ELN count was not an independent predictor of CSS and OS regardless of lymph node status.
Conclusion: The number of ELNs is an independent prognostic factor in patients with stage IA2–IIB cervical cancer. A higher number of ELNs is associated with better survival outcomes, especially in the node-positive SCC subtype.
Keywords: cervical cancer, early stage, SEER, histological subtype, nodal positive, prognosis
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