Lymph node ratio may predict the benefit of postoperative radiotherapy in node-positive cervical cancer.
The standard treatment for node-positive cervical cancer after radical hysterectomy is pelvic radiotherapy and concurrent chemotherapy. Given the potential toxicity of postoperative radiotherapy, we used the lymph node ratio (LNR) to assess the benefit of postoperative radiotherapy in lymph node-positive cervical cancer patients. Data from the Surveillance Epidemiology and End Results database (1988-2010) were analyzed using Kaplan-Meier and Cox regression proportional hazard analysis. A total of 2,269 eligible patients were identified (median follow-up, 78.0 months); 1,863 (82.1%) patients received postoperative radiotherapy. In both univariate and multivariate analysis multivariate analysis, a higher LNR was significantly associated with a poorer outcome. A LNR > 0.16 was associated with poorer cervical cancer-related survival (CCSS) (hazard Ratio [HR] 1.376, confidence interval [CI] 1.082-1.750; P < 0.001) and overall survival (OS) (HR 1.287, CI 1.056-1.569; P = 0.012). Postoperative radiotherapy was only associated with survival benefits in patients with a LNR > 0.16 (CCSS, P < 0.001; OS, P < 0.001) and not in patients with a LNR ≤ 0.16 (CCSS, P = 0.620; OS, P = 0.167); these trends were not affected by number of removed lymph nodes. A higher LNR is associated with a poorer survival in lymph node-positive cervical cancer. The survival benefits of postoperative radiotherapy appear to be limited to patients with a LNR > 0.16.
['Zhou|Juan|J|', 'Chen|Qiong-Hua|QH|', 'Wu|San-Gang|SG|', 'He|Zhen-Yu|ZY|', 'Sun|Jia-Yuan|JY|', 'Li|Feng-Yan|FY|', 'Lin|Huan-Xin|HX|', 'You|Ke-Li|KL|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D019540:Area Under Curve D005260:Female D006801:Humans D053208:Kaplan-Meier Estimate D008207:Lymphatic Metastasis D008875:Middle Aged D016016:Proportional Hazards Models D012372:ROC Curve D018714:Radiotherapy, Adjuvant D018426:SEER Program D016896:Treatment Outcome D002583:Uterine Cervical Neoplasms D055815:Young Adult
lymph node ratio postoperative radiotherapy cervical cancer survival SEER