Prognostic significance of histology and positive lymph node involvement following radical hysterectomy in carcinoma of the cervix

• Published in: American journal of clinical oncology Vol. 32; no. 4; pp. 411 - 416
• Main Authors: Macdonald, O Kenneth, Chen, Jergin, Dodson, Mark, Lee, Christopher M, Gaffney, David K
• Format: Journal Article
• Language: English
• Published: United States 01-08-2009
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Analysis of Variance; Chi-Square Distribution; Disease-Free Survival; Female; Humans; Hysterectomy - methods; Lymph Node Excision - methods; Lymph Nodes - pathology; Lymphatic Metastasis; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness - pathology; Neoplasm Staging; Predictive Value of Tests; Probability; Prognosis; Proportional Hazards Models; Registries; Risk Assessment; SEER Program; Survival Analysis; Treatment Outcome; United States; Uterine Cervical Neoplasms - mortality; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; Young Adult; United States
• ISSN: 0277-3732; 1537-453X
• DOI: 10.1097/coc.0b013e31819142dc

Lymph node (LN) metastasis portends a poor outcome in women with carcinoma of the uterine cervix. We queried a large database to analyze the importance of number of positive LN and histology in relation to survival after radical hysterectomy and lymphadenectomy.
Data were collected from the Surveillance, Epidemiology, and End Results Program on women who had primary surgery for the years 1988 to 2003 (n = 4559). Statistical analyses were performed using conventional methods.
The median number of LNs examined per patient has significantly declined in recent years (P = 0.003). The 5-year rates of cause specific and overall survival were 94% and 91%, 76% and 69%, 62% and 58%, and 41% and 35%, for 0, 1 to 2, 3 to 9 and > or =10 positive LNs, respectively. Pathologic LN involvement was associated with higher grade, higher stage, larger tumor size, and squamous cell histology. Predictors for both cause specific and overall survival on multivariate analysis included number of involved LN, histology, tumor grade, tumor size, disease stage, and pelvis or paraaortic lymphatic involvement.
Adenocarcinoma histology independently predicted for a more aggressive phenotype, particularly in women with LN involvement. The number of LNs examined did not independently predict for survival when adjusted for patient and disease characteristics, providing context for the investigation of sentinel node biopsy or other sampling methods. LN positive disease in carcinoma of the cervix predicts a prognosis that is inversely related to the number of involved nodes. Tumor grade, size, and FIGO stage were associated with increasing risk for lymph node metastases.