Lymph node metastasis as a prognostic factor in patients with cervical cancer

Kim, Seok Mo; Choi, Young Sam; Kim, Ki Min; Na, Jae Ho; Rim, So Yi; Choi, Ho Sun; Byun, Ji Soo

Abstract

OBJECTIVES
To elucidate the prognostic significance of the number and level of the involvement of lymph node metastases(LNM) in patients with early cervix cancer. MATERIALS AND METHODS: Radical hysterectomy and bilateral pelvic lymphadenectomy were done on 366 patients diagnosed with cervical carcinoma stages I B and II A from june 1985 to June 1994 at Chonnam National University Hospital, Kwangju, Korea. Survival analysis was performed using the Kaplan-Meier estimator. RESULTS: The 5 year survival rate in 296 patients without LNM was 95% versus 78% in 70 patients with LNM(p<0.01). In 56 patients (80%) with single LNM, the 5-year survival rate was 85% versus 50% in 14 patients (20%) with multiple LNM (p<0.01). The 5-year survival rate in the 7 patients (10%) with extrapelvic LNM (in the common iliac or paraaortic nodes) was 20%. The 5-year survival rate of the 63 patients (90%) with LNM below the level of the common iliac nodes was 84.6%. The difference was statistically significant (p<0.01). There was no involvement of the common iliac or paraaortic lymph nodes without pelvic node involvement. CONCLUSIONS: These figures suggest that the number and site of positive nodes are more important prognostic factor than the existence of nodal metastasis. Although we need a randomized prospective study, it might be expected that the 5-year survival rates of those patients with one positive pelvic node can be improved up to the level of those without nodal metastasis without postoperative adjuvant radiation and/or chemotherapy.