Lymph Node Ratio Is a Strong Prognostic Factor in Patients with Early-Stage Cervical Cancer Undergoing Minimally Invasive Radical Hysterectomy

• Published in: Yonsei medical journal Vol. 62; no. 3; pp. 231 - 239
• Main Authors: Kim, Se Ik, Kim, Tae Hun, Lee, Maria, Kim, Hee Seung, Chung, Hyun Hoon, Lee, Taek Sang, Jeon, Hye Won, Kim, Jae-Weon, Park, Noh Hyun, Song, Yong-Sang
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01.03.2021; 연세대학교의과대학
• Subjects: Adult; Aged; Disease-Free Survival; Female; Humans; Hysterectomy; Lymph Node Ratio; Lymph Nodes - pathology; Lymphatic Metastasis - pathology; Middle Aged; Minimally Invasive Surgical Procedures; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Original; Prognosis; Proportional Hazards Models; Retrospective Studies; Survival Analysis; Treatment Outcome; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; 의학일반; radical hysterectomy; recurrence; lymph node ratio; minimally invasive surgery; laparoscopic surgery; Cervical cancer
• ISSN: 0513-5796; 1976-2437; 1976-2437
• DOI: 10.3349/ymj.2021.62.3.231

To determine whether the prognostic impact of lymph node ratio (LNR), defined as the ratio between the number of positive lymph nodes and removed lymph nodes, differs between open and minimally invasive surgical approaches for radical hysterectomy (RH) in node-positive, early-stage cervical cancer. We retrospectively identified 2009 International Federation of Gynecology and Obstetrics stage IB1-IIA2 patients who underwent primary type C RH between 2010 and 2018. Among them, only those with pathologically proven lymph node metastases who received adjuvant radiation therapy were included. The prognostic significance of LNR was investigated according to open surgery and minimally invasive surgery (MIS). In total, 55 patients were included. The median LNR (%) was 9.524 (range, 2.083-62.500). Based on receiver operating characteristic curve analysis, the cut-off value for LNR (%) was determined as 8.831. Overall, patients with high LNR (≥8.831%; n=29) showed worse disease-free survival (DFS) than those with low LNR (<8.831%, n=26) ( =0.027), whereas no difference in overall survival was observed. Multivariate analyses adjusting for clinicopathologic factors revealed that DFS was adversely affected by both MIS [adjusted hazard ratio (HR), 8.132; =0.038] and high LNR (adjusted HR, 10.837; =0.045). In a subgroup of open surgery cases, LNR was not associated with disease recurrence. However, in a subgroup of MIS cases, high LNR was identified as an independent poor prognostic factor for DFS (adjusted HR, 14.578; =0.034). In patients with node-positive, early-stage cervical cancer, high LNR was associated with a significantly higher disease recurrence rate. This relationship was further consolidated among patients who received MIS RH.