잠시만 기다려 주세요. 로딩중입니다.

Lymph Node Ratio Is a Strong Prognostic Factor in Patients with Early-Stage Cervical Cancer Undergoing Minimally Invasive Radical Hysterectomy

Yonsei Medical Journal 2021년 62권 3호 p.231 ~ 239
김세익, 김태훈, 이마리아, 김희승, 정현훈, 이택상, 전혜원, 김재원, 박노현, 송영상,
소속 상세정보
김세익 ( Kim Se-Ik ) - Seoul National University College of Medicine Department of Obstetrics and Gynecology
김태훈 ( Kim Tae-Hun ) - Seoul Metropolitan Government-Seoul National University Boramae Medical Center Department of Obstetrics and Gynecology
이마리아 ( Lee Maria ) - Seoul National University College of Medicine Department of Obstetrics and Gynecology
김희승 ( Kim Hee-Seung ) - Seoul National University College of Medicine Department of Obstetrics and Gynecology
정현훈 ( Chung Hyun-Hoon ) - Seoul National University College of Medicine Department of Obstetrics and Gynecology
이택상 ( Lee Taek-Sang ) - Seoul Metropolitan Government-Seoul National University Boramae Medical Center Department of Obstetrics and Gynecology
전혜원 ( Jeon Hye-Won ) - Seoul Metropolitan Government-Seoul National University Boramae Medical Center Department of Obstetrics and Gynecology
김재원 ( Kim Jae-Weon ) - Seoul National University College of Medicine Department of Obstetrics and Gynecology
박노현 ( Park Noh-Hyun ) - Seoul National University College of Medicine Department of Obstetrics and Gynecology
송영상 ( Song Yong-Sang ) - Seoul National University College of Medicine Department of Obstetrics and Gynecology

Abstract


Purpose: To determine whether the prognostic impact of lymph node ratio (LNR), defined as the ratio between the number of positive lymph nodes and removed lymph nodes, differs between open and minimally invasive surgical approaches for radical hysterectomy (RH) in node-positive, early-stage cervical cancer.

Materials and Methods: We retrospectively identified 2009 International Federation of Gynecology and Obstetrics stage IB1-IIA2 patients who underwent primary type C RH between 2010 and 2018. Among them, only those with pathologically proven lymph node metastases who received adjuvant radiation therapy were included. The prognostic significance of LNR was investigated according to open surgery and minimally invasive surgery (MIS).

Results: In total, 55 patients were included. The median LNR (%) was 9.524 (range, 2.083?62.500). Based on receiver operating characteristic curve analysis, the cut-off value for LNR (%) was determined as 8.831. Overall, patients with high LNR (≥8.831%; n=29) showed worse disease-free survival (DFS) than those with low LNR (<8.831%, n=26) (p=0.027), whereas no difference in overall survival was observed. Multivariate analyses adjusting for clinicopathologic factors revealed that DFS was adversely affected by both MIS [adjusted hazard ratio (HR), 8.132; p=0.038] and high LNR (adjusted HR, 10.837; p=0.045). In a subgroup of open surgery cases, LNR was not associated with disease recurrence. However, in a subgroup of MIS cases, high LNR was identified as an independent poor prognostic factor for DFS (adjusted HR, 14.578; p=0.034).

Conclusion: In patients with node-positive, early-stage cervical cancer, high LNR was associated with a significantly higher disease recurrence rate. This relationship was further consolidated among patients who received MIS RH.

키워드

Cervical cancer; radical hysterectomy; minimally invasive surgery; laparoscopic surgery; lymph node ratio; recurrence

원문 및 링크아웃 정보

 

등재저널 정보