Effect Of Lymph Node Ratio On The Prognosis Of â… B1-â…¡B Cervical Cancer

Backround:Cervical cancer is one of the most common gynecological malignancies in developing countries.According to the clinical stage,surgical resection is the main treatment for all cervical cancer≤IIA.When there are high risk factors and several medium risk factors,radiotherapy and chemotherapy are recommended.Nodal status is the most important prognostic in cervical cancer.It is of great significance to know whether the patients have lymph node metastasis and the extent of metastasis in order to evaluate the prognosis of patients and formulate postoperative adjuvant treatment for patients with cervical cancer.Lymph node ratio,was calculated as the number of positive lymph nodes divided by the number of lymph nodes removed and given as a percentage.It has been established as a valid prognostic factor in several non-gynecological solid tumors.This study investigate the value of lymph node metastasis in the prognosis of cervical cancer,and analyzed other factors affecting the prognosis of cervical cancer patients with lymph node metastasis.The multivariate survival analysis was used to compare the effect of LNR and the number of lymph node metastasis PFS and OS,and the difference between the two in predicting the prognosis of patients with cervical cancer.Material and Methods:Records the clinical data of 486 patients treated with radical hysterectomy and pelvic lymphadenectomy in Guangxi Medical University Affiliated Tumor Hospital from 2013 to 2016 and were retrospectively analyzed.The characteristics of patients and tumors including age,BMI,clinical FIGO stage,type of surgery,pathological type,histological grading,tumor-free margins,lymphovascular space invasion,deep muscle invasion and postoperative adjuvant treatment,number of lymph node metastasis(pelvic and para-aortic)and number of lymph nodes removed(pelvic,para-aorticand and total).The patients were divided into groups according to the number of number of positive nodes(1-3 or≥4),LNR(≤7.6%or>7.6%and≤6.6%or>6.6%).All patients were followed-up for more than 5 years.SPSS Statistics,version 23was used for statistical analysis;χ~2test was used to compare in Between-group comparisons;Mann-Whitney U test was used to compare parameters such as age,BMI and number of lymph nodes were removed.In order to analys the influence of lymph node metastasis(yes or no),1-3 or≥4 positive nodes number,LNR≤7.6%or>7.6%,LNR≤6.6 or>6.6%on PFS and OS,Kaplan Meier method,log rank test and univariate cox regression models were used.We used adjusted multivariable cox regression models with a stepwise backward selection procedure(Wald statistics),including both number of positive lymph nodes(1–3vs.4 or more)and LNR(either≤7.6%vs>7.6%or≤6.6%vs.>6.6%),to evaluate which of these two variables of interest is better suited as a prognostic parameter for PFS and/or OS in node-positive cervical cancer patients.Result:(1)Lymph node metastasis is a risk factor for OS of patients with cervical cancer(HR 5.025,95%CI 3.266-7.732,P<0.001).(2)In univariate survival analysis;Type of surgery,tumor-free margins,deep muscle invasion,age,clinical FIGO stage,pathological type and radiotherapy are the influencing factors of PFS.Tumor-free margins,deep muscle invasion,age,clinical FIGO stage,pathological type and radiotherapy are the influencing factors of OS.(3)Both in univariate analysis and adjusted multivariate cox regression,patients with≥4 lymph node metastasis is prognostic factor of worse PFS and OS.(4)Both in univariate analysis and adjusted multivariate cox regression,LNR(≤7.6 or>7.6%and≤6.6 or>6.6%);Both of them are significant prognostic factors for PFS and OS.(5)In cervical cancer patients with lymph node metastasis,the number of lymph node metastasis(≥4 or 1-3)was significantly correlated with lymph node ratio(LNR>6.6%or LNR≤6.6%and LNR>7.6%or LNR≤7.6%);(both P<0.001).(6)When the cut-off value of LNR was 7.6%,compared with the absolute number of positive lymph node;Whether for PFS or OS,it is a better prognosis predictor.Conclusion:In surgical cervical cancer,the ratio of lymph nodes is a better predictor of prognosis than the absolute number of positive lymph node.