The variable impact of positive lymph nodes in cervical cancer: Implications of the new FIGO staging system.

Autor: McComas KN; University of Utah School of Medicine, Salt Lake City, UT, USA., Torgeson AM; University of Utah, Department of Radiation Oncology, Salt Lake City, UT, USA., Ager BJ; University of Utah, Department of Radiation Oncology, Salt Lake City, UT, USA., Hellekson C; University of Utah, Department of Radiation Oncology, Salt Lake City, UT, USA., Burt LM; University of Utah, Department of Radiation Oncology, Salt Lake City, UT, USA., Maurer KA; University of Utah, Department of Obstetrics & Gynecology, Salt Lake City, UT, USA., Werner TL; University of Utah, Department of Internal Medicine, Salt Lake City, UT, USA., Gaffney DK; University of Utah, Department of Radiation Oncology, Salt Lake City, UT, USA. Electronic address: david.gaffney@hci.utah.edu.
Jazyk: angličtina
Zdroj: Gynecologic oncology [Gynecol Oncol] 2020 Jan; Vol. 156 (1), pp. 85-92. Date of Electronic Publication: 2019 Nov 16.
DOI: 10.1016/j.ygyno.2019.10.025
Abstrakt: Objective: The 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer changed from a clinical system to a clinical/pathologic/radiologic system with stages IIIC1 and IIIC2 indicating positive pelvic and para-aortic lymph nodes, respectively. We evaluated the National Cancer Database (NCDB) for the impact on survival of lymph node metastases (LNM).
Methods: The NCDB from 2004 to 2015 was queried for patients with cervical cancer, yielding 115,819 patients. Patients with FIGO IVB (22,569), non-adeno/squamous cell histologies (5,909), unknown nodal status (60,695), or unknown survival time (9,473) were excluded. Survival was compared using Cox proportional hazard model based on nodal status. Univariate (UVA) and multivariate analyses (MVA) were done for the overall cohort, followed by UVA by individual stage.
Results: In 17,173 eligible patients, LNM negatively affected survival (UVA IIIC1 Hazard Ratio [HR] 2.0, p < 0.001, IIIC2 HR 3.9, p < 0.001, MVA IIIC1 HR 1.36, p < 0.001, IIIC2 HR 2.14, p < 0.001). In T1B, the effect of IIIC2 was most pronounced (HR 5.38, p < 0.001 versus HR 1.5 p = 0.001 for IIIC1 disease). In T3, the effect of LNM was markedly less: (HR 1.7, p < 0.001 for IIIC2 versus HR 1.2 p = 0.02 for IIIC1). Within T1B, there was no difference in survival for IIIC1 for the smaller T stages (IB1-2).
Conclusion: In this study, LNM negatively affects prognosis in cervical cancer. The impact on survival varies by T stage with the greatest effect seen in stage T1B with IIIC2 disease.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: