Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea.
Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea.
Gynecol Oncol. 2018 Mar;148(3):449-455. doi: 10.1016/j.ygyno.2018.01.005. Epub 2018 Jan 10.
Lymph node involvement is an important prognostic factor in patients with cervical cancer. However, the prognostic significance of lymph node response to chemoradiotherapy remains unclear. We retrospectively analyzed the relationship between residual lymph node status after definitive chemoradiotherapy and survival.
We enrolled 117 patients with node-positive cervical cancer. All patients were treated with definitive chemoradiotherapy in our institution, from 2006 to 2016. The median follow-up period was 41months (range, 6-128months). The criterion for a positive lymph node was defined as a maximum short axis diameter of ≥8mm on pretreatment magnetic resonance imaging (MRI)/computed tomography (CT) scans. Posttreatment pelvic MRI was obtained 3months after the completion of chemoradiotherapy. Residual primary tumor was defined as any residual lesion identified upon clinical examination and/or MRI. Residual lymph node was defined as any lymph node with a short axis diameter of ≥8mm posttreatment, according to MRI/CT.
At follow-up, 3months after chemoradiotherapy, we observed residual primary tumor in 30 patients (25.6%), and residual lymph node in 31 patients (26.5%). The presence of residual lymph node was associated with worse overall survival according to multivariate analysis (hazard ratio, 3.04; 95% confidence interval, 1.43-6.44; p=0.004). In the 5-year time-dependent ROC analysis of survival prediction, the presence of residual lymph node showed an AUC value of 0.72.
The presence of residual lymph node after chemoradiotherapy was associated with worse survival in patients with node-positive cervical cancer.
淋巴结受累是宫颈癌患者的一个重要预后因素。然而，放化疗后淋巴结反应的预后意义仍不清楚。我们回顾性分析了根治性放化疗后残留淋巴结状态与生存的关系。
我们纳入了 117 例淋巴结阳性的宫颈癌患者。所有患者均在我院接受根治性放化疗，时间为 2006 年至 2016 年。中位随访时间为 41 个月（范围为 6-128 个月）。术前磁共振成像（MRI）/计算机断层扫描（CT）检查中最大短轴直径≥8mm 的淋巴结被定义为阳性淋巴结。放化疗后 3 个月行盆腔 MRI 检查。残留的原发性肿瘤定义为临床检查和/或 MRI 发现的任何残留病变。残留淋巴结定义为根据 MRI/CT，治疗后短轴直径≥8mm 的任何淋巴结。
随访至放化疗后 3 个月时，我们观察到 30 例（25.6%）患者存在残留原发性肿瘤，31 例（26.5%）患者存在残留淋巴结。多因素分析显示，存在残留淋巴结与总生存时间较差相关（风险比，3.04；95%置信区间，1.43-6.44；p=0.004）。在生存预测的 5 年时间依赖性 ROC 分析中，残留淋巴结的存在显示 AUC 值为 0.72。
放化疗后存在残留淋巴结与淋巴结阳性宫颈癌患者的生存时间较差相关。
