The prognostic value of the presence of pelvic and/or para-aortic lymph node metastases in cervical cancer patients; the influence of the new FIGO classification (stage IIIC)

• Published in: Gynecologic oncology 2023-04, Vol.171, p.9-14
• Main Authors: van Kol, K.G.G, Ebisch, R.M.F, van der Aa, M, Wenzel, H.B, Piek, J.M.J, Bekkers, R.L.M
• Format: Article
• Language: English
• Subjects: Cervical cancer; Female; FIGO; Hematology, Oncology, and Palliative Medicine; Humans; Lymph Node Excision - methods; Lymph node metastases; Lymph Nodes - pathology; Lymphatic Metastasis - pathology; Neoplasm Staging; Obstetrics and Gynecology; Prognosis; Retrospective Studies; Survival; Uterine Cervical Neoplasms - pathology
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2023.01.023

AbstractIntroductionOne of the major changes in the revised (2018) FIGO-staging system is the addition of stage IIIC to the previously used 2009 system. We evaluated the prognostic value of positive pelvic and/or para-aortic lymph nodes in patients with cervical cancer. MethodsA nationwide retrospective cohort study was performed by analyzing data from the Netherlands Cancer Registry. All patients newly diagnosed with stage IB-IVA between 2005 and 2018 were identified. Three-year, 5-year and 15-year overall survival (OS) rates were estimated with the Kaplan-Meier method. ResultsOf the included 6082 patients, 1740 patients (29%) had pelvic and/or para-aortic lymph node metastases. For patients with FIGO 2009 stage IB-IB1-IIA-IIA1 and stage IB2-IIA2-IIB with pelvic and/or para-aortic lymph node metastases the OS was significantly different ( p < 0.001 and p = 0.009), with a 5-year OS of 77% and 67%, compared with 92% and 74% for women without lymph node metastases. For FIGO 2009 stage IIIA-IIIB-IVA with and without lymph node metastases, survival rates are not significantly different ( p = 0.064). For FIGO 2018 stage IIIC the 3y-OS, 5y-OS and 15-year OS are 72%, 65% and 59% respectively. Survival rates of IIIC diagnosed based on imaging (IIICr) are significantly impaired compared to stage IIIC diagnosed based on pathology (IIICp) ( p < 0.001). ConclusionPatients with FIGO 2009 stage IB–IIB cervical cancer with pelvic and/or para-aortic lymph node metastases have significantly impaired survival compared to patients without metastases. Survival rates of patients with FIGO 2009 stage IIIA–IVA are not affected by lymph node metastases.