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.

OBJECTIVE.: The objective of this study was to compare the significance of numbers of metastatic (MLN) and removed lymph nodes (RLN) between primary surgical treatment (PST) and neoadjuvant chemotherapy followed by surgery (NCS) in patients with FIGO stage IB1 to IIA cervical cancer. METHODS.: Among 1124 patients with cervical cancer, PST (n=451) and NCS (n=73) groups were enrolled for evaluating the association between numbers of MLN and RLN, and clinical outcomes including the pattern of recurrence and survival according to the 2 treatments. RESULTS.: Mean values of progression-free survival (PFS) were 100.8 vs. 87.6 vs. 57.7 months in 0 vs. 1-2 vs. ≥3 MLN, suggesting that ≥3 MLN was associated with poor PFS (adjusted HR, 2.71; 95% CI, 1.02 to 7.21). However, there was no association between the number of MLN and survival in NCS group. The increased number of MLN was also associated with the increase of distant metastasis in PST group (44.0% vs. 72.7% vs. 78.6%; p=0.02), whereas there was no association between the number of MLN and the pattern of recurrence in NCS group. Moreover, mean values of PFS were 57.2 (<20 RLN) vs. 77.9 months (≥20 RLN) in PST group with lymph node metastasis (p=0.04), demonstrating that ≥20 RLN improved PFS in PST group (adjusted HR, 0.48; 95% CI, 0.25 to 0.95). CONCLUSIONS.: The increased number of MLN may be more significant for predicting poor survival and distant metastasis, and the increased number of RLN may be associated with better survival in the patients treated with PST than those treated with NCS.