Li Anyang, Wang Luhui, Jiang Qi, Wu Wenlie, Huang Baoyou, Zhu Haiyan
Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 200126, People's Republic of China.
Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, People's Republic of China.
Cancer Manag Res. 2020 Jul 28;12:6431-6439. doi: 10.2147/CMAR.S253522. eCollection 2020.
Stage IIIC1 cervical cancer showed heterogeneous in oncologic outcomes with highly variable survival rates. Our objective was to determine the prognostic significance of removed and metastatic pelvic lymph node status and further perform risk stratification in patients with stage IIIC1p cervical cancer.
Patients with stage IIIC1p cervical cancer and undergoing radical hysterectomy with lymphadenectomy in 2008-2018 were retrospectively analyzed. Patients' stage was classified using the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) staging schema. Univariate and multivariable models were used to examine the association between removed and metastatic lymph node status and recurrence-free survival/overall survival.
During a median follow-up of 34 months, 73 relapses and 44 deaths were observed among 273 patients with stage IIIC1p cervical cancer. Parametrial involvement and metastatic lymph node ratio (mLNR) were identified as independent predictors for recurrence-free survival. Parametrial involvement and mLNR were independent predictors for overall survival. A stratification system was then created based on parametrial involvement and mLNR. A total of 123 (45.1%), 127 (46.5%) and 23 (8.4%) patients were classified into the low-risk, intermediate-risk, and high-risk groups, with as a 5-year recurrence-free survival of 81.7%, 51.1%, 38%, respectively. Compared to the low-risk group, the intermediate- and high-risk groups had a significantly greater risk of recurrence and death.
The prognosis of stage IIIC1p patients varied significantly. A risk stratification system based on parametrial involvement and mLNR successfully separated patients into low, intermediate, and high-risk group. Our findings could facilitate the practical use of further stratification in Stage IIIC1p cervical cancer.
IIIC1期宫颈癌的肿瘤学结局存在异质性，生存率差异很大。我们的目的是确定切除的和转移的盆腔淋巴结状态的预后意义，并进一步对IIIC1p期宫颈癌患者进行风险分层。
回顾性分析2008年至2018年接受根治性子宫切除术及淋巴结清扫术的IIIC1p期宫颈癌患者。患者的分期采用2018年修订的国际妇产科联盟（FIGO）分期方案。采用单变量和多变量模型来检验切除的和转移的淋巴结状态与无复发生存率/总生存率之间的关联。
在中位随访34个月期间，273例IIIC1p期宫颈癌患者中观察到73例复发和44例死亡。宫旁受累和转移淋巴结比率（mLNR）被确定为无复发生存率的独立预测因素。宫旁受累和mLNR是总生存率的独立预测因素。然后根据宫旁受累和mLNR创建了一个分层系统。共有123例（45.1%）、127例（46.5%）和23例（8.4%）患者被分为低风险、中风险和高风险组，5年无复发生存率分别为81.7%、51.1%、38%。与低风险组相比，中风险和高风险组的复发和死亡风险显著更高。
IIIC1p期患者的预后差异很大。基于宫旁受累和mLNR的风险分层系统成功地将患者分为低、中、高风险组。我们的研究结果有助于在IIIC1p期宫颈癌中进一步分层的实际应用。
