216\u2005The deleterious survival impact of positive lymph nodes in cervical cancer: implications of the new FIGO staging system

Abstract

Objectives The 2018 FIGO (International Federation of Gynecology and Obstetrics) cervical cancer staging system 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 a nation-wide hospital database for the impact on survival of lymph node involvement. Methods The National Cancer Database from 2004–2015 was queried for patients with cervical cancer, yielding 115,819 patients. Patients with metastatic disease (22,569), non-adeno/squamous 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 (node-negative [N0], positive pelvic nodes [IIIC1], or positive para-aortic nodes [IIIC2]). Univariate (UVA) and multivariate analyses (MVA) were done for the overall cohort, followed by UVA by T stage. Results 17,173 patients were eligible. Lymph node involvement negatively affected survival in the overall cohort (UVA IIIC1 Hazard Ratio [HR] 2.0, p<0.001, IIIC2 HR 3.85, p<0.001, MVA IIIC1 HR 1.36, p<0.001, IIIC2 HR 2.14, p<0.001) and in FIGO stages IB-III individually. In FIGO IB, the effect of IIIC2 was most pronounced (HR=5.38, p<0.001 versus HR 1.5 p=0.001 for IIIC1 disease) compared to FIGO III (HR 1.698, p<0.001 for IIIC2 versus HR 1.19 p=0.02 for IIIC1). Within FIGO IB, there was no difference in survival for IIIC1 compared to N0 for FIGO IB1 and IB2. Conclusions In this study, lymph node involvement negatively affects prognosis in cervical cancer. The impact on survival varies by T stage with the greatest effect seen in stage IB.