Prognostic Factors For Survival in Patients with Lymph Node Metastasis Identified at the Time of Surgery for Cervical Carcinoma

Sung, Jeong Hee; Kim, Byoung Sub; Lee, Eun Hee; Yun, Chang Beom; Ryu, Sang Young; Kim, Jong Hoon; Kim, Byoung Gie; Park, Sang Yoon; Lee, Eui Don; Lee, Kyung Hee

Abstract

The presence of metastatic lymph nodes in cervical carcinoma is one of the most important prognostic factors to survival. In general, the characteristics of metastatic lymph nodes such as number, site, and bilaterality etc. can modify the survival of patients with lymph node metastasis. This nonrandomized retrospective study was performed to identify prognostic factors for survival in patients with FIGO stage IA2, I B and IIA, IIB carcinoma of the cervix with nodal metastases. From January 1, 1993, to December 31, 1995, 86 patients with FIGO stage I A, I B and IIA, IIB carcinoma of the cervix were found to have nodal metastasis at the time of radical hysterectomy and pelvic lymphadenectomy at the Department of Obstetrics and Gynecology, Korea Cancer Center Hospital. The prognostic significance of number of metastatic lymph nodes, site(s) of lymph node metastases, cervical lesion size, age, FIGO stage have been evaluated. In this study, the 3-year disease free survival rate (DFSR) and clinical characteristics were compared with the prognostic factors. Univariate analysis revealed significant that number of metastatic lymph nodes (p=0.0008) and tumor size (p=0.0490) were significant prognostic factor, but there were no significant differences in 3-year DFSR according to age (p=0.1257), FIGO stage (0.4687), site(s) of lymph node metastases (p=0.5552). However, by multivariate analysis only number of metastatic lymph nodes (p=0.0248) was noted to be a significant prognostic factor determining survival of the patient. A risk of recurrence increased continuously in accordance with increased of the number of metastatic lymph nodes. In particular the 3-year DFSR fell markedly from 85.3% in patient with less than four metastatic lymph node to 25.9% in those with five or more metastatic lymph node (p=0.0008). These results demonstrated that the number of metastatic lymph nodes was the most important and independent prognostic factor in patients with cervical cancer showing lymph node metastasis.